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Endocrine SOH > Infertility > Flashcards

Infertility Flashcards

1
Q

Infertility is failure to achieve a clinical pregnancy after at least ____ months of regular unprotected sex in a couple who have never had a child

A

12

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2
Q

Primary infertility

A

Couple have never conceived

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3
Q

Secondary infertility

A

Couple have previously conceived but have lost the baby during pregnancy

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4
Q

Causes

A 
Older women trying to conceive 
Increasing male factor fertility
Rise in chlamydia infections 
Increase in obesity
Same sex couples 
Increased awareness of treatments 
Endometriosis 
Ovulatory dysfunction
Tubal disorder
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5
Q

Female investigations

A 
General exam: BMI, body hair distribution
Pelvic exam
Midluteal progesterone levels 
Endocervical swab for chlamydia 
Test tubal patency
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6
Q

What are normal mid luteal progesterone levels

A

over 30nmol/L in 2 separate samples

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7
Q

Male investigations

A

General exam: BMI
Genital exam: size and position of testes
Semen analysis
Measure LH, FSH, testosterone, prolactin, thyroid function
Chromosomal analysis

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8
Q

Female causes of infertility (4)

A

Anovulatory infertility
Tubal disease
Hydrosalpinx
Endometriosis

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9
Q

Anovulatory infertility - definition

A

Overies don’t release an egg

Thus ovulation does not occur

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10
Q

Anovulatory infertility - physiological causes

A

Before puberty
Pregnancy
Menopause

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11
Q

Anovulatory infertility - hypothalamic causes

A

Anorexia
Bullimia
The ovaries don’t release an egg as the patient is not healthy enough)

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12
Q

Anovulatory infertility - pituitary causes

A

Tumours

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13
Q

Anovulatory infertility - ovarian causes

A

PCOS

Premature ovarian failure

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14
Q

Anovulatory infertility - endocrine causes

A

Testosterone secreting tumours

Congenital adrenal hyperplasia

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15
Q

Anovulatory infertility - drug causes

A

Explanon
OCP
Depo-provera

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16
Q

Tubal disease - definition

A

Fallopian tubes are blocked/damaged

This restricts the egg from making the journey from the ovary to the uterus

17
Q

Tubal disease - infective causes

A

Chlamydia
Appendicitis (transperitoneal spread)
Hysteroscopy

18
Q

Tubal disease - non-infective causes

A

Endometriosis
Fibroids
Polyps
Surgery

19
Q

Tubal disease - investigations

A

Hydrosalpinogram

Laparoscopy - if there is known previous pathology

20
Q

Tubal disease - management

A

Tubal surgery

IVF

21
Q

Hydrosalpinx - definition

A

Distally blocked fallopian tube filled with clear fluid

22
Q

Hydrosalpinx - clinical features

A 
Abdominal / pelvic pain 
Vaginal discharge
Dyspareunia 
Infertility - ectopic pregnancy 
Dysmennorrhoea
23
Q

Hydrosalpinx - management

A

IVF treatment

24
Q

Endometriosis - definition

A

Presence of endometrial glands outside the uterine cavity

i.e. the lining of the womb comes outside of the womb

25
Q

Endometriosis - clinical features

A 
Dysmennorrhoea 
Dyspareunia 
Chronic pelvic pain 
Excessive bleeding 
Infertility
26
Q

Endometriosis - investigations

A

“chocolate cysts” on ovary

27
Q

Endometriosis - management

A

Pain relief

28
Q

Male non-obstructive causes of infertility

A

Torsion
Trauma
Iatrogenic - chemotherapy, radiotherapy
Chromosomal abnormality - klinefelters

29
Q

Non obstructive male infertility - endocrine features

A

Increased FSH
Decreased LH
Decreased testosterone

30
Q

Non obstructive male infertility - clinical features

A

Reduced secondary sexual characteristics

31
Q

Obstructive male infertility - causes

A

Congenital absence of vas deferens (e.g. CF)
Infection
Vasectomy

32
Q

Obstructive male infertility - endocrine features

A

Normal FSH
Normal LH
Normal testosterone
(all hormones are normal, there is just an obstruction)

33
Q

Obstructive male infertility - clinical features

A

Normal secondary sexual characteristics

Vas deferens may be absent

34
Q

Obstructive male infertility - management

A

Surgery to obstructed vas deferens
Intrauterine insemination
Sperm injection

Endocrine SOH (25 decks)

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