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Women's Health 2 > Infertility > Flashcards

Infertility Flashcards

1
Q

infertility definition

A

no pregnancy after 1 year of unprotected well timed intercourse

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2
Q

fecundability

A

probability of pregnancy in a single menstrual cycle

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3
Q

fecundity

A

probability of live birth in a single menstrual cycle

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4
Q

fertile window

A

6-day interval ending on the day of ovulation

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5
Q

when is the highest fecundity?

A

w/i 2 days of ovulation

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6
Q

what can maximize the likelihood of conception?

A

increasing frequency of intercourse beginning soon after cessation of menses and continuing to ovulation

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7
Q

home ovulation monitoring is only recommended for who?

A
  • pts w/ regular cycles

- only accurate 50% of the time

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8
Q

fecundability (prob. of pregnancy per month for fertile couples planning to conceive) for

  • daily intercourse
  • alternate days
  • once a week
A
  • daily: 37%
  • alternate: 33%
  • once/week: 15%
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9
Q

optimal frequency of intercourse

A
  • every 1-2 days but factor in patient stress

- cycles days 10-20 probably hit the fertile window in most cases

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10
Q

lubricants that are ok

A
  • mineral oil
  • canola oil (WUT??)
  • hydroxyethylcellulose - based lubricants (Pre-seed, ConveivEase)
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11
Q

lubricants that are not ok

A
  • olive oil
  • salive
  • astroglide
  • KY
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12
Q

how does BMI effect fertility?

A
  • BMI > 35 can double time to pregnancy

- BMI < 19 can quadruple time to pregnancy

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13
Q

lifestyle factors that effect fertility

A
  • smoking increases infertility by 60%
  • alcohol > 2 drinks/day increases infertility by 60%
  • drugs can increase infertility 70%
  • toxins at work can increase infertility 40%
  • caffeine > 250mg daily can decrease pregnancy rates (controversial)
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14
Q

recommended folic acid

A

400 mcg to reduce NTDs

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15
Q

effects of smoking

A
  • OR of infertility is 1.6
  • menopause occurs 1-4 yrs earlier
  • increases risk of miscarriage
  • decreases sperm density, motility and morphology - but no definite decrease in male fertilty
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16
Q

what factors make up fertility evaluation?

A
  • H&P
  • assessment of ovulation
  • ovarian reserve testing
  • uterine abnormalities
  • tubal patency
  • male fertility testing
  • optimization of medical conditions and medications
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17
Q

H&P for fertility

A
  • duration
  • menstrual hx
  • pregnancy hx
  • gyn hx
  • previous method of contraception
  • coital frequency and sexual dysfunction
  • PSH
  • PMH
  • meds
  • fam and social hx
18
Q

PE for fertility

A
  • vitals
  • thyroid
  • breasts
  • signs of androgen excess
  • pelvic exam
19
Q

what accounts for 40% of infertility in women?

A

-ovulatory dysfunction (MC is PCOS)

20
Q

evaluation of ovulation

A
  • hx: regular periods is a good indication of ovulation

- are they using home-checking methods?

21
Q

lab test for ovulation

A
  • serum progesterone
  • get 1 week before expected onset of menses
  • if > 3ng/mL presumed ovulation
22
Q

meds that can induce ovulation

A
  • clomiphene citrate (clomid)
  • letrozole (femara)
  • gonadotropins (follistim, gonal-F)
23
Q

MoA of clomiphene citrate

A
  • selective E receptor modulator
  • interrupts the negative feedback b/w estradiol and FSH
  • FSH increases, facilitating follicle growth and ovulation
24
Q

MoA of letrozole

A
  • aromatase inhibitor, blocks production of estradiol
  • also interrupts the negative feedback b/w estradiol and FSH
  • off label
25
Q

tx for pts resistant to meds

A
  • gonadotropins

- ovarian drilling

26
Q

what is ovarian reserve

A
  • reproductive potential as a function of the number and quality of remaining oocytes
  • gives a sense of how quickly a pt is reproductively aging
27
Q

evaluation of ovarian reserve

A
  • cycle day 3 FSH and estradiol
  • day 3 antral follicle count by US
  • serum AMH level
28
Q

when is the only time you can interpret FSH?

A

if estradiol is low

29
Q

what is the antral follicle count

A
  • sum of antral follicles in both ovaries

- low count is associated w/ poor response to ovarian stimulation

30
Q

serum AMH level

A
  • AMH is produced by granulosa cells of early follicles

- relatively consistent levels during menstrual cycle

31
Q

low AMH (< 1-2 nl/ml) is associated with what?

A
  • poor response
  • poor embyro quality
  • poor pregnancy outcomes in IVF
32
Q

tx for low ovarian reserve

A
  • not possible to reserve process
  • worse response to all types of tx offered
  • therapy aimed at increasing chance of pregnancy each month
  • donor oocyte or embry
33
Q

tubal disease

A

-obstructed fallopian tubes block egg and sperm from ever meeting

34
Q

RFs for tubal disease

A
  • hx of STI (esp. chlamydia)
  • hx of pelvic surgery
  • hx of ectopic pregnancy
  • hx of appendicitis
35
Q

processes to check for tubal patency

A
  • hysterosalpingogram

- laparoscopy w/ chromopertubation

36
Q

tx for tubal obstruction

A
  • rarely gets surgery

- more often use in vitro

37
Q

evaluation to check for uterine abnormalities

A
  • HSG to look at size and shape of uterine cavity, developmental or acquired anomalies
  • sonohysterography to look for polyps or fibroids
  • hysteroscopy: definitive for diagnosis and tx of intrauterine pathology
38
Q

male factor is responsible for infertility how often?

A

about 20% of cases but is a contributor to about 30-40% of cases

39
Q

factors of a semen analysis

A
  • volume
  • concentration
  • motility
  • morphology
  • total motile count
40
Q

tx for male factor infertility

A
  • referral to urology
  • hormone testing
  • if counts are minimally decreased: intrauterine insemination
  • counts very low: IVF
41
Q

indications to refer

A
  • trying over 12 mos
  • trying over 6 mos if female > 35
  • abnl semen analysis
  • irregular periods
  • suspect PCOS or tubal blockage
  • no success after 3 cycles of clomid

Women's Health 2 (9 decks)

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