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Reproduction Pathology > Infertility > Flashcards

Infertility Flashcards

1
Q

80% of couples will conceive in one year IF

A

Women is under 40 y/o AND

They do not use contraception and have regular sexual intercourse

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2
Q

Biochemical measurements of hirsutism

A 
Testosterone 
Androstenedione 
Dehydropiandrosterone (DHA)
Dehydroepiandrosterone sulphate (DHAS)
17-OH-Progesterone
Sex hormone binding globulin (SHBG)
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3
Q

Baseline investigations for female partner

A

Rubella immunity
Chlamydia has to be negative
TSH
If periods are regular = mid luteal progesterone (7 days prior to expected periods)
If periods are irregular = day 1-5 full hormonal profile (FSH, LH, PRL, TSH, testosterone)

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4
Q

Baseline investigations for male partner

A

Semen analysis

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5
Q

Testing for ovulation

A

Regular cycle = blood test to measure serum progesterone in mid luteal phase of their cycle (day 21 of 28)

Irregular prolonged cycle = blood test to measure serum progesterone - needs to be done later in the cycle and repeated weekly until next period

Irregular cycle = blood test to measure serum gonadotrophins (LH and FSH)

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6
Q

When to refer to infertility clinic

A 
Trying for one year
Unless there is a problem e.g. 
- Period irregularity 
- PMH
- testicular problem 
Abnormal tests 
HIV/Hep B
Anxiety
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7
Q

Treatment of ovulatory disorders

A

Treat underlying cause
Weight loss/gains = BMI > 18 and < 35
Ovulation induction

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8
Q

Ovulation induction drugs

A

Clomifene
Gonadotrophins
GnRH

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9
Q

First line drug for ovulation induction

A

Clomifene

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10
Q

Mode of action of clomifene

A

Oestrogen receptor modulation - binds to oestrogen receptors
Hypothalamus perceives hypoestrogenic state - pituitary increases release of gonadotrophins
Secondary site of action = direct effect on ovaries
So gives a positive trigger to release FSH and LH

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11
Q

How many times can clomifene be used?

A

Up to 6 times

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12
Q

Side effects of clomifene

A

Vasomotor

Visual

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13
Q

Treatment of male infertility

A 
IVF/ICSI
Intra uterine insemination 
Donor insemination 
Surgery 
- removal of vasectomy
- surgical sperm revival
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14
Q

Investigations for azoospermia

A

History and exam

FSH, LH, testosterone, karyotype, PRL, CF screen

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15
Q

How IVF works

A
  1. Eggs harvested from ovaries
  2. Eggs fertilised in lab with sperm
  3. Embryos undergo a number of cell divisions
  4. Embryos transferred to the womb
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16
Q

Primary infertility meaning

A

If have had no children before

17
Q

Irregular periods definition

A

Variation of 7 days or more from the other months

18
Q

Side effects of any ovulation induction

A

Ovarian hyperstimulation

Multiple pregnancy

19
Q

How to diagnose tubal block

A

Salpingogram
HyCoSY
Laparoscopy to confirm

20
Q

Causes of tubal block

A

PID
If tubes are removed e.g. sterilisation
Endometriosis
Fibroids

21
Q

IVF meaning

A

In vitro fertilisation (outside the body)

22
Q

Azoospermia meaning

A

No sperm in the ejaculate

23
Q

Causes of azoospermia

A 
Absence of vas deferens 
Mumps
Kleinfiers syndrome
STIs
Radiation 
Hypogonadism
24
Q

Unexplained fertility meaning

A

Everything is fine but there is still no fertility

25
Q

What is the overall success rate for IVF?

A

20 - 30 %

26
Q

What ethical issues could surround IVF?

A 
Unnatural 
Funding 
Religion 
Criteria 
Risks
27
Q

What is IVF a moderate risk factor for?

A

Placental abnormalities

28
Q

How long do patients need to be trying to conceive for to be referred on?

A

1 year

29
Q

How many couples will be affected by infertility?

A

1 in 7

30
Q

Causes of inferility

A 
Male factor 30%
Unexplained 20% 
Ovulation failure 20% 
Tubal damage 15% 
Other causes 15%
31
Q

Key counselling points for conception

A

Folic acid
Aim for BMI 20 - 25
Advise regular sexual intercourse every 2 - 3 days
Smoking / drinking advise

32
Q

For people with unexplained fertility, mild endometriosis or mild male factor infertility who are having regular unprotected sexual intercourse, what can be done?

A

Make sure they try for 2 years naturally

33
Q

Common S/E of IVF

A

Ovarian hyper stimulation syndrome

Reproduction Pathology (28 decks)

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