infertility Flashcards
Why do male patients with CF have azoospermia?
congenital absence of vas deferens (thick secretions obstruct fetal vas deferens and it obstructs) - sperm can be extracted from the epididymus
What kind of ovarian failure is PCOS?
Type II (hypothalmic -pituitary-ovarian failure)
What is the first line treatment for type II ovarian failure?
Weight reduction if BMI >30
clomifene and/or metformin
What is the second line treatment for type II ovarian failure?
clomifene and metformin or ovarian drilling (laparoscopic) or gonadotrophins
What tests are recommended by NICE for assessment of infertility in all women?
Chlamydia
mid-luteal phase progesterone
What test result is suggestive of anovulation as the cause of infertility from primary tests recommended by NICE?
low mid-luteal progesterone <16nmolL
What tests are generally performed before referral to an infertility clinic?
chlamydia mid-luteal phase progesterone FSH LH prolactin thyroid
What are the features of a type III ovarian failure?
Anovulation/menopause
High FSH/LH
Low progesterone <16nmol/l
How would you treat subfertility due to type III ovarian failure?
IVF donor eggs
What are the features of menopausal ovaries?
ovarian volume on ultrasound is less than 2cubic cm
How is menopause diagnosed in patients older than 45?
symptoms of menopause (irregular periods/vasomotor symptoms) or 12 months no period without contraception
How is menopause diagnosed in patients younger than 45?
Symptoms of menopause/perimenopause + elevated FSH levels
What HRT can be given to women with or without a uterus?
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)
Which two conditions cause congenital absence of the uterus?
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
How do you diagnose PCOS?
Rotterdam criteria 2/3
Polycystic ovaries (either 12 or more follicles or >10cm3 in volume)
anovulation or oligovulation
clinical or biochemical signs of hyperandrogenism