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Women's Health > Infertility > Flashcards

Infertility Flashcards

1
Q

Components of female fertility history?

A
  • Age
  • Development
  • Menstrual cycle
  • Pregnancies
  • Time trying to conceive
  • Previous contraception
  • Stigmata endometriosis
  • Sexual patterns
  • Med / surg / psych
  • Family
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2
Q

Components of male fertility history?

A
  • Age
  • Past fertility
  • Development
  • Sexual function
  • Testicular: trauma, descent, torsion
  • Med / surg / psych
  • Family
  • Vasectomy
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3
Q

What are the broad components of infertility investigation?

A
  • Hormones
  • Genetics
  • Imaging
  • Screening
  • Semen analysis
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4
Q

What is the reproductive age range?

A

15-44 years approx

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5
Q

What is infertility?

A

Failure of couple to conceive after 12 months of frequent, unprotected intercourse

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6
Q

What is the series of events broadly required for conception?

A

1) - Ovulation of competent oocyte
2) - Production of competent sperm
3) - Juxtaposition of sperm and oocyte in a patent reproductive tract and subsequent fertilisation
4) - Generation of a viable embryo
5) - Transport of embryo into uterine cavity
6) - Successful implantation of the embryo into the endometrium

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7
Q

How does progesterone secretion relate to the menstrual cycle and conception?

A

Secretion of progesterone by the corpus luteum dominates the luteal phase of the menstrual cycle and persists if conception occurs

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8
Q

What does progesterone do to the cervical mucous?

A

Acts on endocervix to convert thin, clear cervical mucous into sticky mucoid material

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9
Q

What does progesterone do to basal body temperature?

A

Changes thermoregulatory set point resulting in basal body temp rise

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10
Q

Which tests provide indirect evidence of ovulation and timing?

A
  • Basal body temp

- LH urine kits

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11
Q

What is the initial evaluation for ovulation?

A
  • Hx and PEx
  • Basal body temp charting
  • Ovulation predictor kits
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12
Q

What are the further evaluations for ovulation?

A
  • Mid luteal phase progesterone level
  • Ultrasonography
  • Endometrial biopsy (not routine)
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13
Q

What are the initial and further evaluation investigations for the uterus?

A 
Initial: US
Further: 
-saline infusion ultrasonography
-Hysterosalpingography
-MRI
-Hysteroscopy
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14
Q

Initial evaluation of male infertility?

A
  • Semen analysis
  • Repeat if indicated
  • Postcoital test (not routine)
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15
Q

When is uterus assessment particularly important in infertility work up?

A

Uterine abnormalities usually cause pregnancy loss. Important to assess if:

  • abnormal bleeding
  • pregnancy loss
  • preterm delivery
  • previous uterine surgery
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16
Q

What are the important characteristics of a normal hysterosalpingography (HSG)?

A
  • Uterine cavity smooth and symmetrical (indentations / irregularities suggest leiomyomas, polyps, adhesions)
  • Proximal 2/3 fallopian tube thin (~ diameter of pencil lead)
  • Distal third = ampulla; dilated cf proximal portion of tube
  • Free spill of dye from fimbriae outlining bowel etc in pelvic cavity
17
Q

Causes of pelvic adhesions

A
  • infection (PID, appendicitis)
  • endometriosis
  • abdominal / pelvic surgery
18
Q

How should semen analysis be collected and performed?

A
  • Obtained by masturbation after 2-3 days of abstinence
  • Analyse within 1h
  • Evaluate quantity and quality of seminal fluid, sperm concentration, sperm motility and morphology
19
Q

What are the groups of male factor infertility aetiology?

A
  • Hypothalamic pituitary disease causing gonadal dysfunction
  • testicular disease
  • post testicular defects impeding disorders of transport or ejaculation
  • unexplained
20
Q

How long does sperm production and development take?

A

~70 days

21
Q

When should endocrine evaluation be undertaken in male factor infertility investigation?

A

Individuals with abnormal sperm concentrations or signs of androgen deficiency

22
Q

How can primary and secondary hypogonadism be detected?

A

Serum FSH, LH and testosterone

  • Primary: low testosterone, elevated FSH / LH
  • Secondary: low testosterone, FSH and LH
23
Q

What is the hormone pattern in exogenous steroid use?

A

Low LH in presence of oligospermia and normal testosterone level

24
Q

What should be assessed in men with low serum testosterone?

A

Serum prolactin

25
Q

When is genetic testing indicated for sperm?

A

Azoospermia or severe oligospermia

26
Q

What are the most common genetic abnormalities producing decreased sperm count?

A
  • CFTR (Cystic fibrosis)
  • Somatic and sex Chr abnormalities
  • microdeletions of Y chromosome
27
Q

When is ovulation stimulation indicated? What must be done first

A

Women with anovulation or oligo-ovulation.
BUT
any identified condition a/w ovulatory disorders should be treated before initiating ovulation induction therapy (e.g. thyroid disorders, PCOS, high stress)

28
Q

What is the medication commonly used for ovulation induction?

A

Clomiphene citrate:

  • SERM competitively inhibits oestrogen binding to oestrogen receptors at hypothalamus and pituitary
  • causes gonadotropin release from pituitary stimulating follicle development in ovaries
29
Q

How is clomiphene administered?

A

Daily for 5 days in the follicular phase of the menstrual cycle starting between days 3-5

30
Q

What are the risks of clomiphene?

A
  • Multigestation 10% (usually twins)

- Ovarian hyper stimulation and cyst formation

31
Q

What is controlled ovarian hyper stimulation?

A

Exogenous gonadotropins given to stimulate follicular development. Aims to achieve mono follicular ovulation in anovulatory women. Can be purified human or recombinant FSH, LH.

32
Q

How is IUI conducted?

A
  • Ejaculated semen washed to remove bacteria, PGs, proteins
  • Sperm suspended in medium
  • Speculum inserted into vagina
  • Specimen placed into thin flexible catheter which is advanced through the cervix
33
Q

What is ART?

A

All fertility procedures involving the manipulation of gametes, zygotes, or embryos to achieve conception

34
Q

What is the process of IVF?

A
  • Ovarian stimulation to produce multiple follicles
  • Retrieval of oocytes from ovaries
  • Oocyte fertilisation in vitro in lab
  • Embryo incubation in lab
  • Transfer of embryo to uterus via cervix
35
Q

What are the medications required for IVF?

A
  • Gonadotropins to stimulate follicle development
  • Gonadotropin releasing hormone analogue (agonist or antagonist) to prevent premature ovulation during follicle development
  • hCG to initiate final maturation of oocytes prior to their retrieval
  • Progesterone to ensure endometrial secretory changes and support potential pregnancy
36
Q

What are the indications for IVF?

A
  • Absent / blocked FTs
  • Tubal sterilisation
  • Failed surgery to achieve tubal potency
  • Severe pelvic adhesions
  • Severe endometriosis
  • Poor ovarian response to stimulation
  • Oligo ovulation
  • Severe male factor infertility
  • Unexplained infertility
  • Failure with more conservative treatments

Women's Health (39 decks)

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