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Summer FDTN Exam 3 > infertility > Flashcards

infertility Flashcards

1
Q

What are the types of infertility

A

primary: has never had a child before
secondary: has had a child prior
- both require women 35+ unable to conceive for 6+ months

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2
Q

What is fecundability

A

Likelihood you will get pregnant in any menstrual cycle

typically 20-25%

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3
Q

85% of couples will get pregnant with

A

regular, unprotected sexual intercourse

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4
Q

Infertility is MC

A 
female factor (65%) 
male only 20%, and 15% unexplained
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5
Q

What are ways you can prevent infertility

A

Discuss fertility and oocyte cryopreservation at WWE
Anovulation is associated with weight extremes
Tobacco/recreational drug cessation
decrease alcohol
avoid vaginal lubricants
avoid scrotal hyperthermia

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6
Q

Factors contributing to female infertility include

A 
Ovulatory d/o: PCOS, hyperPRL, ovarian failure, low weight, excess exercise 
Endometriosis 
Pelvic adhesions 
Tubal blockage (STD, PID) 
HyperPRL
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7
Q

Factors contributing to male infetility include

A

Defects in spermatogenesis*
Idiopathic
Sperm transport d/o
hypogonadotropic hypogonadism

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8
Q

Initiate infertility evaluation earlier IF

A

FHx of premature ovarian failure, severe endometriosis, or known/suspected uterine or tubal disease

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9
Q

What are the 4 key aspects of fertility

A

Sperm
Oocyte
Transport
Implantation

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10
Q

Labs helpful in infertility evaluation include

A 
hCG 
TSH
PRL
total T
DHEA
FSH/LH 
estradiol
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11
Q

Female infertility PE work up should include

A

thyroid exam

assessment of cervix, uterine abnormalities, and adnexal masses

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12
Q

When evaluating the female for infertility, I want to ensure

A 
Menstrual cycle is normal (good Hx) 
Ovulation occurring (urine/serum LH surge test/check serum progesterone at day 21 in Luteal phase)
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13
Q

If a woman is anovulatory, you should

A

Evaluate for thyroid d/o, and hyperPRL
Get additional labs- day 3 serum FSH and estradiol
FSH high & Estradiol low= Ovarian failure
FSH low-norm & Estradiol low= hypo or pit failure

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14
Q

What tests assess ovarian reserve

A

US for follicular antral follicle count
Antimullerian hormone
Clomiphene challenge test

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15
Q

What diagnostic test has the added benefit of being therapeutic for women

A

Hysterosalpingography; some women get pregnant after doing this, but that’s just a plus
Laparoscopy/hysteroscopy with dye can also be therapeutic!

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16
Q

Laparoscopy/hysteroscopy with dye can be used to evaluate

A

endometriosis
prior pelvic infection
prior ectopic

17
Q

Normal semen analysis results are

A

Count: 20+ million/mL
Motility: >50%
Morphology: >30% normal
no sex 3 days prior to test. must eval semen 1-2 hrs after collection

18
Q

Male labs to get for infertility evaluation include

A

testosterone (if low, order PRL)
FSH/LH
PRL

19
Q

If semen analysis comes back abnormal

A

repeat in 4 weeks
further evaluate: endocrine, urological, genetic
consider toxin exposure
If count <5 million, do an endocrine evaluation or karyotype

20
Q

What do different lab levels in men indicate

A

Low T, High FSH/LH: Primary hypogonadism
Low T, Low FSH/LH: Secondary hypogonadism
Low LH, low sperm count, Normal T: patient may be taking exogenous steroids

21
Q

Unexplained normal findings that require referral to infertility specialist include

A

normal uterine cavity
bilateral patent tubes
evidence of ovulation
normal semen analysis

22
Q

What patient education can you give younger couples having difficulty conceiving

A

Timed intercourse! make sure they understand ovulation

Lifestyle mod- BMI, Tobacco cessation, Diet

23
Q

What two meds can be taken by women to assist fertility

A

Comiphene (clomid)

Letrozole (femara)

24
Q

What is Clomid

A

a SERM that inhibits negative feedback of estrogen and stimulates the ovaries to release more eggs
1st choice for women <36 w/ oligomenorrhea or amenorrhea w/ normal FSH (aka PCOS pts)
8% twin gestation rate!

25
Q

ADE of Clomid include

A 
hot flashes 
emotionally labile 
depression
bloating
visual changes 
-aka, estrogen s/e!
26
Q

What is Letrozole

A

an Aromatase inhibitor; reduce estrogen conversion

Good for women with a history of estrogen dependent tumors because you get way less estrogen than clomid

27
Q

What are indications for using Gonadotropins to induce ovulation

A 
when using WITH IUI (intrauterine insemination) 
-human Menopause Gonadotropin (hMG) 
Recombinant FSH (rFSH)
28
Q

ADE of gonadotropins include

A

multiple gestation
ovarian hyperstimulation syndrome
high risk ectopic pregnancy

29
Q

If infertility is 2/2 a pelvic factor, what interventions can you apply

A

endometriosis: Laparoscopy

Myomectomy ONLY if: recurrent abortion, repeat implant failure, submucosal leiomyoma distorting endometrial cavity

30
Q

If infertility is 2/2 cerivcal factors, what can you do

A

IUI to bypass cervical mucus

Empiric Tx with Doxycycline

31
Q

Available ART (assisted reproductive technologies) include

A 
IUI (artificial insemination) 
ICSI (intracytoplasmic sperm injection- w/ IVF) 
IVF 
GIFT (gamete intrafallopian transfer) 
ZIFT (zygote intrafallopian transfer 
Donor oocytes or sperm
32
Q

Describe IUI

A

Good for mild-mod male factor infertility (less motile sperm)
Sperm are washed (remove prostaglandins, bacteria, and protein)
Sperm injected into uterus transcervically
10-20% pregnancy rate

33
Q

Describe ICSI

A

Good for severe male infertility
Used with IVF
Sperm individually injected into oocyte
20% pregnancy rate

34
Q

What is IVF

A

-Monitor follicle development by US and estradiol levels
-When follicle is mature, retrieve oocytes before ovulation (transvaginal aspiration)
-Incubate oocyte with sperm for IVF (with ICSI)
-1-3 Embryos transferred to uterine cavity thru cervix on day 3-5 after getting oocyte
-Supplement progesterone through 10 weeks gestation if conception happens
20% pregnancy rate

35
Q

Describe GIFT

A 
egg and sperm are placed in the fallopian tube 
fertilization occurs in the body 
requires laparoscopy 
25% pregnancy rate 
-Good for some very religious couples
36
Q

Describe ZIFT

A

Zygote is placed into fallopian tube
Fertilization is in vitro, but natural implantation occurs
Rewuires laparoscopy
30% pregnancy rate

37
Q

What is surrogacy

A

your own egg/sperm are implanted into another woman to carry.
state specific, and VERY expensive

38
Q

Prognosis of infertility with UNdiagnosed etiology

A

60% achieve pregnancy w/in 3 years without Tx

39
Q

What is a possible complication of infertility Tx (clomid)

A

Clomiphene citrate increases the rate of cervical cancer when used >12 cycles
LIMIT to 6 cycles!

Summer FDTN Exam 3 (25 decks)

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