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Endocrine- Sex Hormones > Infertility > Flashcards

Infertility Flashcards

1
Q

What part of the sperm forms the:

a) Acrosome?
b) Flagellum?

A

a) Golgi apparatus

b) Centriole

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2
Q

The acrosome of the sperm contains many of the lytic proteins which are required for what?

A

Digestion of the zona pellucida of the egg

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3
Q

Where does the egg settle in fertilisation?

A

The ampulla of the fallopian tube

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4
Q

What is capacitation? Where does it occur?

A

The penultimate stage of maturation of the sperm, occurring in the female genital tract, taking 5-7 hours

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5
Q

Sperm penetration of the egg has what 3 effects?

A

Triggers the egg to complete meiosis, a cytoplasmic rearrangement, increased metabolic activity

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6
Q

A dramatic increase in the levels of what in the egg shortly after the sperm makes contact acts as a secondary messenger to initiate changes?

A

Free intracellular Ca++

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7
Q

What is the association between chlamydia infection and infertility?

A

1 infection = 10% chance of tube damage, 3 infections = 50% chance of tube damage

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8
Q

What defines infertility?

A

Failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sex in couple who have never had a child (in the absence of a known reason)

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9
Q

What is primary infertility?

A

The couple have never conceived before

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10
Q

What is secondary infertility?

A

The couple have conceived before, even if the pregnancy was unsuccessful

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11
Q

What implies a good prognosis in infertility?

A

Woman is < 30, short duration of infertility, secondary infertility

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12
Q

What implies a bad prognosis in infertility?

A

Male infertility, endometriosis, tubal factor infertility

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13
Q

What must both halves of the couple not do in order to get NHS infertility treatment? Why is this?

A

They cannot smoke- as either individual smoking halves the chance of a pregnancy

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14
Q

What are some physiological causes of infertility in a woman?

A

Before puberty, pregnancy, lactation, menopausal

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15
Q

What are some hypothalamic causes of infertility in a woman?

A

Anorexia/bulimia, excessive exercise

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16
Q

What are some pituitary causes of infertility in a woman?

A

Hyperprolactinoma, tumours, Sheehan’s syndrome

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17
Q

What are some ovarian causes of infertility in a woman?

A

PCOS, premature ovarian failure

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18
Q

Apart from hypothalamic, pituitary and ovarian problems, what are some other causes of infertility in a woman?

A

Systemic disease (e.g. renal failure), endocrine disorders, CAH

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19
Q

What are the levels of FSH/LH/oestrogen in someone with anorexia?

A

All low

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20
Q

If a patient with anorexia does get pregnant, what is likely to happen?

A

Miscarriage or stillbirth

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21
Q

What are some infective causes of tubal disease?

A

Pelvic inflammatory disease, transperitoneal spread, following procedures

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22
Q

What is pelvic inflammatory disease?

A

Any infection of the female genital tract

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23
Q

What are some non-infective causes of tubal disease?

A

Endometriosis, surgical, polyps, congenital, SIN

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24
Q

What is salpingitis isthmica?

A

Diverticulitis of the Fallopian tube

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25
Q

What should you always screen for before intra-uterine procedures? What should you always give?

A

Screen for chlamydia, give prophylactic antibiotics

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26
Q

What is hydrosalpinx? What may this occur due to?

A

Distal Fallopian tube becomes blocked with fluid, can occur in PID

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27
Q

What are some clinical features of hydrosalpinx?

A

Pain, discharge, dyspareunia, menorrhagia and dysmenorrhoea, infertility

28
Q

What is the treatment for tubal disease? What does the outcome depend on?

A

Surgery- outcome depends on the amount of damage

29
Q

What is endometriosis?

A

The presence of endometrial glands, outside the uterine cavity

30
Q

What is the most likely cause of endometriosis?

A

Retrograde menstruation

31
Q

What is retrograde menstruation?

A

When the menstrual blood flows through the fallopian tube and into the pelvic cavity instead of out of the body

32
Q

How can endometriosis present?

A

Can be asymptomatic, or cause dysmenorrhoea, dyspareunia, menorrhagia, painful defecation, pain, infertility

33
Q

What will a scan of the ovaries show in endometriosis?

A

‘Chocolate’ cysts

34
Q

What are the 2 main groups of pre-testicular infertility?

A

Endocrine causes or coital causes

35
Q

What are some endocrine causes of infertility in males?

A

Hypogonadotrophic hypogonadism, hypothyroidism, hyperprolactinaemia, diabetes

36
Q

What are the 4 main groups of testicular infertility?

A

Genetic, congenital, vascular, immunological

37
Q

What are some genetic causes of male infertility?

A

Kleinfelter’s, Y deletion, immotile cilia

38
Q

Which types of male infertility are non-obstructive?

A

Pre-testicular and testicular

39
Q

Will a vas deferent be present in non-obstructive male infertility?

A

Yes

40
Q

Which type of male infertility is obstructive?

A

Post-testicular

41
Q

What are the 2 groups of post-testicular infertility?

A

Epididymal, vasal

42
Q

Which types of male infertility will have low testicular volume and decreased secondary sexual characteristics?

A

Non-obstructive (pre-testicular and testicular)

43
Q

Which types of male infertility will have normal testicular volume and secondary sexual characteristics?

A

Obstructive (post-testicular)

44
Q

What may be absent in post-testicular male infertility?

A

Vas deferens

45
Q

What will be the levels of LH/FSH/testosterone in non-obstructive infertility in males?

A

High LH/FSH, low testosterone

46
Q

What will be the levels of LH/FSH/testosterone in obstructive infertility in males?

A

Normal

47
Q

What are some drugs which are prone to causing male infertility?

A

Spironolactone, beta blockers, lithium, anti-depressants (also alcohol, tobacco, marijuana)

48
Q

What investigations would you use for female infertility?

A

Chlamydia screen, smear, rubella immunity, test tubal potency, mid-luteal progesterone levels

49
Q

When is a hysterosalpingogram used to assess tubal patency?

A

If there are no risk factors of tubal or pelvic pathology, or if laparoscopy is contra-indicated

50
Q

When is a laparoscopy used to assess tubal patency?

A

If there is possible or known pelvic pathology

51
Q

When there is an abnormality on pelvic exam, what test should be done?

A

Pelvic ultrasound

52
Q

What are some contra-indications to ovarian laparoscopy?

A

Obesity, previous pelvic surgery, Crohn’s

53
Q

When should semen analysis be tested in male infertility?

A

Twice over 6 weeks apart

54
Q

If there is severely abnormal semen analysis in males, what tests should be done?

A

Chromosome analysis, screen for CF, testicular biopsy

55
Q

If there is an abnormality on a male genital exam, what test should be done?

A

Scrotal ultrasound

56
Q

What is the first line treatment for ovarian induction? Give examples.

A

Anti-oestrogens (clomifene crate, tamoxifen) and aromatase inhibitors (letrozole)

57
Q

When should anti-oestrogen be taken?

A

Day 2-6 daily

58
Q

What is the maximum dose of clomifene citrate daily?

A

150mg

59
Q

What are some second line treatments for ovarian induction?

A

Clomifene citrate and metformin, gonadotrophin daily injections, laparoscopic ovarian diathermy

60
Q

When should surgery be used in male infertility?

A

If the vas deferens is obstructed

61
Q

Apart from surgery, what are some other options for male infertility?

A

Intrauterine insemination, donor sperm

62
Q

How many times should ‘infertile’ couples have sex per week?

A

2/3

63
Q

Females should limit alcohol to how many units a week?

A

4

64
Q

BMI for both males and females should be between what?

A

19-29

65
Q

What supplement should the female take?

A

0.4mg folic acid or 5mg if risk of tube defect

66
Q

What should you always remember to check in the investigation of infertility (especially male)?

A

Drugs

Endocrine- Sex Hormones (5 decks)

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