Infertility Flashcards

1
Q

What is the definition of infertility?

A
  • Inability of a couple to achieve a clinical pregnancy within 12 months of beginning regular unprotected sexual intercourse
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2
Q

What is primary infertility?

A

No previous pregnancies

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3
Q

What is secondary infertility?

A

A couple have previously had a child but now can not

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4
Q

What is fecundability?

A

The percentage of women exposed to the risk of pregnancy for one menstrual cycle who will subsequently produce a live born infant (Normal 15-28%)

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5
Q

At what age do fecundity rates begin to decrease?

A
  • Small but noticeable decrease at age 31, more pronounced at age 36 and very steep at 40
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6
Q

What are the main categories for the causes of infertility?

A
  • Ovulation disorders (25%)
  • Male factors (25%)
  • Tubal factors (15%)

Different book says

  • Female (65%)
  • Male (20%)
  • Other (15)
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7
Q

In men who have had infection to the testis or epididymis or who have had reversed vasectomies what may you be more concerned about regarding fertility?

A
  • Antisperm antibodies
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8
Q

What is the chromosomal abnormality found in Turner syndrome?

A
  • 45,XO
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9
Q

What is the pathophysiology behind weight-related anovulation

a) low weight
b) high weight

A

a) A minimum percentage of body fat is required to maintain ovulatory cycles (typically 22%ish)
- weight reduction leads to disappearance of normal 24h secretory pattern of GnRH resulting in anovulation

b) Overweight - likely due to excess androgen from adipose tissue converting androgens.
- Interferes with normal feedback mechanism in pituitary

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10
Q

What is luteinized unruptured follicle syndrome?

A
  • occurs when the oocyte is retained following the luteinizing hormone surge
  • No studies have been done longitudinally to show if this is longstanding or recurring or if affects fertility
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11
Q

What are some symptoms that would make you concerned about hyperprolactinemia?

A
  • Galactorrhea (10-15%)

- Bitemporal hemianopia (if pituitary adenoma)

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12
Q

What are the gonadotrophins?

A
  • Luteinizing hormone

- Follicle stimulating hormone

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13
Q

What is the mechanism behind anovulation in hyperprolactinemia?

A
  • High levels of prolactin inhibit the release of gonadotrophins (LH and FSH) which are required for ovulation to occur
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14
Q

Name 3 methods of determining if ovulation is occuring in a female

A

1) History: over 90% of women with regular menstrual cycles will ovulate spontaneously
2) Urine LH kit: Urine test which can pick up the mid-cycle LH surge that leads to ovulation
3) Mid-luteal (7-10 days before next cycle) progesterone level: Progesterone is produced by corpus luteum. Therefore levels over 28

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15
Q

Explain how basal body temperature can be used to test for ovulation? What temperature change are you expecting?

A
  • After ovulation the corpus luteum produces progesterone
  • Progesterone is pyrogenic and increases body temperature which can be monitored
  • 0.5 degree Celsius change after ovulation and during luteal phase
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16
Q

What is a progesterone challenge? What does it test?

A
  • 5 days of oral progesterone, followed by withdrawal
  • A bleed following shows that the patient is well estrogenized (estrogen causing endometrial growth) and progesterone inducing it to shed.
17
Q

How can you induce ovulation in patients with hyperprolactinemia? What is the mechanism?

A
  • You can use a dopamine agonist (bromocriptime, carergoline)
  • Dopamine inhibits the secretion of prolactin allowing for ovulation to occur
18
Q

How can you treat anovulation in patients with polycystic ovarian syndrome?

A
  • First line pharmacologic treatment is with anti-estrogen therapy
  • Decreased estrogen -> stops it’s negative feedback on hypothalamus -> higher FSH levels
  • Weight loss should be acheived or attempted prior in younger women with ovarian reserve *
  • Many will ovulate spontaneously following and increases live-birth rate
19
Q

How do you treat anovulation in estrogen-deficient women?

A
  • Exogenous gonadotrophins (LH, FSH)
  • Monitor follicle growth with U/S
  • Exogenous hCG to induce ovulation mid cycle (replaces LH surge)
  • Start w low dose to decrease change of multiple pregnancy
20
Q

What treatment options exist for those with tubal disease looking to become pregnant?

A
  • Tubal surgery

- In vitro fertilization (used more often due to advances in technique)

21
Q

What is one of the major risks of pregnancy after tubal surgery?

A
  • Higher incidence of ectopic tubal pregnancy
22
Q

What is azoospermia?

A
  • Medical condition of a man where the semen contains no sperm
23
Q

Why do you test FSH in a man with azoospermia? What do the results tell you?

A

1) High FSH: FSH encourages speratogenesis in males, if this is not occurring it will continue to produce more
- This indicates non-obstructive azoospermia
2) Low FSH: Signifies an obstructive azoospermia from a block of the vas deferens or epididymis. Most common in those who have had vasectomy

24
Q

What is in-vitro fertilization?

A
  • In vitro: performed in test tube, culture plate or elsewhere outside of a living organism
  • In this context mixing of egg and sperm occurs outside of the body
25
Q

What is intracytoplasmic sperm injection? What advantage does it have over IVF?

A
  • Sperm is injected directly into the oocyte.
  • In IVF the two are just mixed
  • Advantage in being able to treat most male factor infertility problems
26
Q

When do you start investigating someone for infertility? What can change this?

A

1) Age under 35: 1 year
2) Age 35+: 6 months
3) Symptoms suggestive of underlying cause: right away
(ex: signs of PCOS, Endometriosis, etc..) you would investigate for suspected cause