infertility Flashcards

1
Q

Why do male patients with CF have azoospermia?

A

congenital absence of vas deferens (thick secretions obstruct fetal vas deferens and it obstructs) - sperm can be extracted from the epididymus

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2
Q

What kind of ovarian failure is PCOS?

A

Type II (hypothalmic -pituitary-ovarian failure)

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3
Q

What is the first line treatment for type II ovarian failure?

A

Weight reduction if BMI >30

clomifene and/or metformin

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4
Q

What is the second line treatment for type II ovarian failure?

A
clomifene and metformin
or
ovarian drilling (laparoscopic)
or 
gonadotrophins
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5
Q

What tests are recommended by NICE for assessment of infertility in all women?

A

Chlamydia

mid-luteal phase progesterone

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6
Q

What test result is suggestive of anovulation as the cause of infertility from primary tests recommended by NICE?

A

low mid-luteal progesterone <16nmolL

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7
Q

What tests are generally performed before referral to an infertility clinic?

A
chlamydia
mid-luteal phase progesterone
FSH
LH
prolactin
thyroid
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8
Q

What are the features of a type III ovarian failure?

A

Anovulation/menopause
High FSH/LH
Low progesterone <16nmol/l

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9
Q

How would you treat subfertility due to type III ovarian failure?

A

IVF donor eggs

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10
Q

What are the features of menopausal ovaries?

A

ovarian volume on ultrasound is less than 2cubic cm

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11
Q

How is menopause diagnosed in patients older than 45?

A

symptoms of menopause (irregular periods/vasomotor symptoms) or 12 months no period without contraception

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12
Q

How is menopause diagnosed in patients younger than 45?

A

Symptoms of menopause/perimenopause + elevated FSH levels

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13
Q

What HRT can be given to women with or without a uterus?

A

HRT oestrogen and progesterone for women with a uterus and oestrogen only for women with a uterus (due to oestrogen increasing risk of endometrial cancer)

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14
Q

Which two conditions cause congenital absence of the uterus?

A

Mullerian agenesis AKA Rokitansky-Kuster-Hauser syndrome (1 in 5000), karyotype 46XX (female karyotype but the uterus fails to develop) - normal oestrogen/LH/FSH

Complete Androgen Insensitivity Syndrome AKA Testicular Feminisation Syndrome (1 in 40,000) - karyotype 46XY - low estradiol

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15
Q

How do you diagnose PCOS?

A

Rotterdam criteria 2/3
Polycystic ovaries (either 12 or more follicles or >10cm3 in volume)
anovulation or oligovulation
clinical or biochemical signs of hyperandrogenism

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16
Q

What are the clinical features of PCOS?

A

oligo-ovulation or anovulation
Clinical signs of hyperandrogenism; hirsuitism, alopecia, acne
Obesity
Hyperinsulinaemia, insulin resistance and type II diabetes

17
Q

What are the potential consequences PCOS?

A

Subfertility
Type II Diabetes or impaired glucose tolerance
Increased of cardiovascular disease
Increased risk of endometrial cancer
obstructive sleep apnoea
psychological issues including depression and anxiety

18
Q

What is acromegaly?

A

A disorder caused by excessive growth hormone production after the growth plates have closed

19
Q

What are the causes of acromegaly?

A

The most common cause is a pituitary adenoma but it can also be caused by ectopic GH or GHRH release from adrenal, pancreatic or lung tumours

20
Q

What is the function of growth hormone?

A

Anabolic effects - increases organ size, promotes protein synthesis
Strengthens bone by increasing calcium retention
Decreases adipose: Increase lipolysis
Increases liver function (increases protein synthesis)
Increases muscle
Increases insulin like growth factor and binding proteins
Increases osteoblast activity (linear growth of bone) via IGF-1

21
Q

Which hormone inhibits growth hormone release?

A

Somatostatin and insulin like growth factor and hyperglycaemia

22
Q

Which hormone stimulates growth hormone release?

A

Decrease in glucose, increase in amino acid, stress, GHRH, grhelin (produced by the stomach) and oestrogen and androgen

23
Q

Which cells are in a pituitary adenoma?

A

Somatotroph cells

24
Q

How is acromegaly diagnosed?

A

Clinical features and raised levels of IGF-1

25
Q

How do you test for hyperandrogenism in PCOS?

A

Measuring free androgen index (total testosterone / sex hormone binding protein x 100)

26
Q

What blood results may you see in PCOS?

A

High or normal total testosterone
High free testosterone levels
Low or normal Sex hormone-binding globulin.
High or normal Free androgen index
High LH in comparison to FSH
Impaired glucose tolerance or high fasting glucose

27
Q

What is the cause of congenital adrenal hyperplasia?

A

95% of cases are due to deficiency in 21-hydroxylase (autosomal recessive)

28
Q

What are the consequences of congenital adrenal hyperplasia?

A

due to deficiency of 21-hydroxalase the adrenal cortex is unable to form cortisol and aldosterone causing a build up of the precursor molecules which results in an increase in androgen formation which cause virilisation in females

29
Q

What level of testosterone would prompt assessment for CAH?

A

> 5nmol/l

30
Q

What are the clinical consequences of CAH?

A

Deficiency in aldosterone = hyponatraemia/hyperkalaemia and hypotension
Deficiency in cortisol = hypoglycaemia and increased ACTH
Increased androgens = clitoral enlargement, early puberty, amenorrhoea or oligo-ovulation, hirtuism, alopecia, acne

31
Q

How do you diagnose CAH?

A

High levels of 17-hydroxyprogesterone (pre-cursor of cortisol), low levels of cortisol and aldosterone and high levels of testosterone, hyponatraemia and hyperkalaemia

32
Q

What is the treatment of CAH?

A

replacement of cortisol (hydrocortisone)

Replacement of aldosterone (fludocortisone)

33
Q

If a patient has PCOS when should they be tested for gestational diabetes?

A

At 24-28 weeks gestation

34
Q

What test should be used to assess for diabetes in patients with PCOS?

A

oral glucose tolerance test, if the result is impaired 7.8-11.1, they should be tested annually

35
Q

What is the cut-off for endometrial hyperplasia in women with PCOS?

A

7mm

36
Q

Prevention of endometrial hyperplasia in PCOS

A

COCP or mirena or progestogens may be used to induce bleeds to protect the endometrium (eg, medroxyprogesterone 10 mg daily for 7-10 days every three months)

37
Q

What treatments can be used for subfertility?

A

clomiphene
clomiphene +/- metformin
Ovarian cauterisation/drilling

38
Q

What is the cause of type 1 ovarian failure?

A

Hypothalmic pituitary (stress/low BMI/exercise induced)

39
Q

What are the treatments of type 1 ovarian failure?

A

weight gain if BMI <19
reduced exercise
pulsatile GNRH or gonadotrophins + LH