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GYN > Infertility > Flashcards

Infertility Flashcards

1
Q

How long to conceive

A

80-90% within 12 months

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2
Q

Timing of Intercourse

A

5-6 days before ovulation, 1-2 days have the best probability of conception

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3
Q

Optimum Semen

A

2-3 days abstinence
Motility >50%, 25% rapid progressive motility
Normal morphology 10-15%

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4
Q

Impact of Tobacco on fertility

A

decreased >10/day

  • Tubal changes, cervical changes, damage to gametes, increase in spontaneous abortion and ectopic
  • Smoking linked to early menopause
  • IVF also lower
  • Improves a year after you quit
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5
Q

Impact of BMI on fertility

A

> 27 or insulin resistance –> androgen excess –> anovulation
-Low BMI –> Hypothalemic amenorrhea (suppression of GnRH)

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6
Q

Impact of Exercise on fertility

A

> 7hours of aerobic/week

–> anovulatory infertility

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7
Q

Impact of ETOH on fertility

A

> 14 drinks or 3-13 drinks/week lead to longer time to achieve pregnancy

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8
Q

Impact of Diet on fertility

A

> mono then trans fat

  • Protein from non meat source
  • Low glycemic index carbs
  • High fat dairy
  • Use of multivitamin and iron
  • Reduced risk of ovulatory disorder
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9
Q

Impact of Caffine on fertility

A

-Conflicting data

TTC

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10
Q

Impact of Stress on fertility

A

Stress –> infertility and infertility –> stress

  • Suggest mediation
  • Provide information about treatment plans
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11
Q

Lifestyle effects on pregnancy

A
  • Cigarettes –> spontaneous abortion, IUGR, preterm labor
  • BMI >30 –> risk of preeclampsia, GD, macrosomia, c/s
  • ETOH –> FAS
  • Caffine –> higher risk of spontaneous abortion
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12
Q

Lifestyle effects on Semen

A
  • Tobacco decrease sperm concentration/motility
  • Decrease BMI increase feritlity
  • ETOH –> reduced testosterone –> decreased sperm or impotence
  • Caffine no evidence
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13
Q

Areas of evaluation

A

Ovulation, fallopian tubes, uterus

Semen

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14
Q

Female factors of infertility

A 
Ovulatory (25%)
Endometriosis (15%)
 Pelvic Adhesions (12%)
Tubal blockage (11%)
Tubal abnormalities (11%)
Hyperprolactemia (7%)
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15
Q

Causes of ovulatory problems

A
  • Stress
  • Lubricant may be toxic to sperm
  • Eating DO/Intense exercise
  • Lacatation
  • PCOS
  • Premature ovarian failure
  • Chronic renal/kidney disease
  • Autoimmune disease
  • Disruption to hypothalamus or pituitary
  • Congenital
  • Hyper or hypothyroidsm
  • Medications - OC, antidepressants, chemo
  • PMH of mumps
  • PSH on cervix (may need intrauterine incemination)
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16
Q

Signs of ovulation

A

Monthly menses, breast tender, dysmenorrhea, bloating

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17
Q

Fallopian abnormalitiy causes

A

PID, endometriosis, adhesions

Check with Hysterosalpinogram

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18
Q

Uterine causes

A

-Fibroids in the cavity, septate uterus, polyps

Check wth US

19
Q

Cervical factors

A

Stenosis impairing mucus production, infection

20
Q

Other causes

A

-Luteal phase defect
-Immunological or thrombophlic
Genetic
-Unexplained (then to IVF or INtrauterine)

21
Q

When to seek help

A

No conception in 12 months

6 months if >35 or RF

22
Q

Semen analysis

A

Collect after 2-7 days of abstinance
Repeat
If 2nd abnomral refer

23
Q

Assessment of ovulation

A
  • Regular cycle and symptoms no test
  • Irregular cycles serum progesterone 18-24 days after menses
  • > 3 is dx of ovulation
24
Q

Management of ovulatory issues

A

> 45 day cycle (PCOS, TSH, Prolactin level)
-Amenorrhea progesterone challenge test (10 mg for 5 days, bleeding in a week indicates enough estrogen, no bleeding is ovarian failure or hypothalemic dysfxn)

25
Q

Ovarian Reserve Tests

A

Test with Day 3 FSH

> or = 20 on day 3 = poor reserve

26
Q

Ovarian reserve levels

A

100 is due to increased premature follicle recruitment and ovarian reserve problem

27
Q

Test if >35 and hx of early menopause

A

Ovulation sxs
FSH
Progesterone

28
Q

Laprascopy - when?

A

Hx or suspicion of endometrisis or adhesions

Extremely painful uterus is indication

29
Q

Treatment of infertility

A 
LIfestyle changes
Acupuncture
Clomiphene Day 3 or 5 at 50mg --> 100 for 6 cycles
-Metformin
-Gonadatropin
-IVF
30
Q

MOA Clompiphene

A
  • Binds to estrogen receptors in pituitary
  • BLocks detection of circulating estrogen
  • Hypothalamus increases secretion of GnRH –> increased FSH and LH
31
Q

Clompiphene ADE

A
  • Hot flash
  • Headaches
  • Ovarian elargmeent
  • Multipe births
32
Q

Aromatase inhibitors

A

-Convert androgens to estrogens
5mg from day 3-7
-Does nto cause cervical mucus thickening
-Reduction in risk of multiple gestation

33
Q

Gonadatropins

A

Pure FSH and LH

  • Directly stimulate ovarian follicles
  • Used with HCG (given once follicle matures)
  • Increased risk of ovarian hyperstimulation
34
Q

Tx Short Luteal Phase

A 
Cycles 35 d or longer
Caused by Low proggesterone from corpus luteum
-Normalize prolactin
-Clomid to induce ovulation
-Progesterone suppositories at mid cycle
35
Q

Hyperprolactinemia

A

20ng

  • Cause: stress, pregnancy, pituitary tumor, nipple stimulation
  • Tx: Doapmine agonist
  • First rule out puituitary tumor
36
Q

Management of Tubal factors

A
  • Tubal flushing
  • IVF
  • Tubal reconstruction for distal obstruction
37
Q

Management of Endometriosis and Uterine abnormalities

A
  • Laproscopic surgery
  • Surgical removal of submucosal fibroids
  • Surgical removal of polyps
  • Repair of uterine abrnomalities such as suptum
38
Q

Management of Cervical Infertility

A
  • intrauterine insemitiona or IVY

- Cerfical dialation by placement of catheter for a few days to tx stenosis

39
Q

Management of Unexplained infertility

A
  • Clomiphene w/or w/out intrauterine insemintation

- Gonadotropin injections with intrauterine insertion for 3 cycles

40
Q

Assited reproductive tech

A
  • IVF
  • GIFT - Gamete intrafallopian transfer (Placing egg and sperm in fallopian tube)
  • Zygote intrafallopian transfer - Fertilized egg placed in fallopian tube
  • Intracystoplasmic sperm injection (inject egg with sperm) IVF and ZIFT
41
Q

Donor requirements

A

18-40
Psych assessment
Limited to 25
Screening for STDs, genetic, suspected heritable disease

42
Q

LIfespan of sperm

A

Frozen 18-24 hours (Insemination 12-24 before ovulation)

Fresh for 2-3 days (Inseminate upt to 3 days before ovulation)

43
Q

Methods of fertilization

A

Fresh sperm - Intravaginal or intracervical, not intrauterine due to potential rxn to proteins, prostaglandins, bacteria

For IUI sperm must be washed

44
Q

Predicting Ovulation

A
  • Cervical changes
  • Basal body temp
  • Ovulation predictor kits, LH surge - within 48 hours of surge
  • Fertility monitors are expensive

GYN (7 decks)

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