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Endocrinology > Infertility > Flashcards

Infertility Flashcards

1
Q

how many couples are affected by infertility

A

1 in 6

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2
Q

how much of the population is infertile

A

8%

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3
Q

what might be causing the rising incidence of infertility

A 
older women
increase in chlamydia infections 
increase in obesity 
increasing male infertility 
increasing awareness of treatments 
change in expectations 
social changes - same sex couples
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4
Q

what is infertility

A

failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse in a couple who have never had a child

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5
Q

what separates primary and secondary infertility

A

primary- couple have never conceived

secondary- couple previously conceived (pregnancy may not have been successful- miscarriage or eptopic pregnancy)

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6
Q

what makes infertility prognosis worse

A 
>30
long duration of infertility 
secondary infertility 
male infertility 
endometriosis
tubal factor infertility
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7
Q

what increases your chance of conception

A

Woman aged under 30 years
• Previous pregnancy
• Less than three years trying to conceive
• Intercourse occurring around ovulation
• Woman’s body mass index (BMI) 18.5 – 30m/kg2
• Both partners non-smokers
• Caffeine intake less than two cups of coffee daily
• No use of recreational drugs

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8
Q

what are the physiological causes of anovulatory infertility

A

before puberty
pregnancy
lactation
menopause

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9
Q

what conditions can cause anovulatory infertility

A

hypothalmic- anorexia/ bulimia, excessive exercise

pituitary- hyperprolactinaemia tumours, sheehan syndrome

ovarian- PCOS, premature ovarian failure

systemic disorders- chronic renal failure

endocrine disorders- testosterone secreting tumours, congenital adrenal hyperplasia, thyroid

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10
Q

what drugs can cause anovulatory infertility

A

depo-provera, explanon, OCP

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11
Q

what are the clinical features of anorexia nervosa

A 
low BMI
hair loss 
increased lanugo 
low pulse and MP (hypothyroid) 
anaemia (vit deficiency)
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12
Q

what are the endocrine markers of anorexia

A

low FSH, LH and osteradiol

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13
Q

what is the commonest endocrine disorder in women

A

polycystic ovary syndrome

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14
Q

what can exacerbate PCOS

A

weight gain

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15
Q

what are the clinical features of PCOS

A

obesity, hirsuitism/ acne, cycle abnormalities, infertility

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16
Q

what are the endocrine markers of PCOS

A

high free androgens, high LH, impaired glucose tolerance

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17
Q

how do you diagnose PCOS

A

must have 2 of:

  • chronic anovulation (no cycle)
  • polycystic ovaries
  • hyperandrogenism (clinical or biochemical)
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18
Q

what lifestyle change can help PCOS

A

weight loss

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19
Q

what is premature ovarian failure

A

loss of normal function of your ovaries before the age of 40

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20
Q

what can cause premature ovarian failure

A

idiopathic, genetic (turners, fragile X), chemotherapy, radiotherapy, oophorectomy (removal of the ovaries)

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21
Q

what are the clinical features of premature ovarian failure

A

hot flushes, night sweats, atrophic vaginitis

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22
Q

what are the endocrine markers of premature ovarian failure

A

high FSH, high LH, low oestradiol

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23
Q

what is wrong in turners

A

missing X

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24
Q

what are the infective causes of tubal disease

A

pelvic inflammatory disease: chlamydia, gonnorrhoea, anaerobes, syphilis, TB)

transperitoneal spread: appendicitis, intra-abdominal abscess

following procedure: IUCD insertion, hysteroscopy, HSG (hysterosalpingogram)

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25
Q

what are the forms of pelvic inflammatory disease

A

endotetrisis, salpingitis, oophoritis, parametritis, tubo-ovarian abcess, peritonitis

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26
Q

what are the non infective causes of tubal disease

A 
endometriosis 
surgical (sterilisation, ectopic pregnancy) 
fibroids 
polyps
congenital 
salpingitis isthmica nodosa
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27
Q

what is a hydrosalpinx

A

distally blocked fallopian tube filled with serous or clear fluid- becomes distended

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28
Q

what are the clinical features of a hydrosalpinx due to pelvic inflammatory disease

A 
abdominal/pelvic pain 
febrile
vaginal discharge 
dyspareunia 
cervial excitation 
menorrhagia 
dysmenorrhoea 
infertility 
ectopic pregnancy
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29
Q

what is endometriosis

A

presence of endometrial glands (what lines the uterus) outside the uterine cavity

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30
Q

what causes endometriosis

A

retrograde menstruation, altered immune function, abnormal cellular adhesion, molecules, genetics

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31
Q

what are the clinical features of endometriosis

A 
dysmenorrhoea (classicaly before menstruation
),
dysparenuia, 
mennorrhagia,
painful defaecation,
chronic pelvic pain,
infertility, 
may be asymptomatic
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32
Q

what can happen to the position of the uterus in endometriosis

A

retorverted (tilted abnormally backwards) and can be fixed

33
Q

what can be seen on scan of endometriosis

A

chocolate cysts on ovary

34
Q

what types of cells are found proliferating in endometriosis

A

glandular epithelium

35
Q

what can cause male infertility

A 
unexplained,
undescended testes , 
urogenital infection, 
sexual factors, 
systemic disease,
varicocele (varicous veins on testes causing them to overheat),
hypogonadism, 
immune system factors,
other causes (drugs)
36
Q

what are the types of pre testicular male infertility causes

A

endocrine and coital disorders

37
Q

what are the endocrine causes of male infertility

A

hypogonadotrophic hypogonadism,
hypothyroidism,
hyperprolactinaemia,
diabetes

38
Q

what are the coital disorders that can cause male infertility

A

erectile dysfunction,

ejaculatory failure

39
Q

what are the types of testicular male infertility

A

genetic, congential, vascular, immunological

40
Q

what are the genetic causes of male infertility

A 
klinefelter syndrome (XXY),
y chromosome deletion, 
immotile cilia syndrome
41
Q

what are the congenital cause of male infertility

A

cyptorchidism,
infective,
activespermatogenic agents (heat, irradiation, drugs, chemotherapy)

42
Q

what are the vascular causes of male infertility

A

torsion

varicocele

43
Q

what are the types of post testicular causes of male infertility

A

obstructive: epididymal and vasal

44
Q

what are the causes of epididymal obstructive male infertility

A

congenital, infective

45
Q

what are the causes of vasal obstructive male infertility

A

genetic: cystic fibrosis
acquired: vasectomy, ejaculatory duct obstruction, accessory gland infection, immunological, idiopathic

46
Q

what are drugs that cause may infertility by decreasing sperm count

A

alcohol, tobacco, marijuana, cocaine, testosterone supplements, chemotherapy, long term use of some antibiotics

47
Q

what are drugs that cause may infertility by creating a hormone imbalance

A

marijuana, testosterone supplements, anabolic steroids

48
Q

what are drugs that cause may infertility by decreasing sex drive

A

excessive alcohol, SSRI antidepressants

49
Q

what are drugs that cause may infertility by causing erectile dysfunction

A

excessive alcohol, tobacco, cocaine

50
Q

what are drugs that cause may infertility by decreasing the ability of sperm to fertilise the egg

A

CCB’s, tetracycline antibiotics

51
Q

what are the clinical features of non obstructive male infertility

A

low testicular volume, reduce secondary sexual characteristics, vas deferens present

52
Q

what are the endocrine features of non obstructive male infertility

A

high LH, FSH and low testosterone

53
Q

what are the clinical features of obstructive male infertility

A

normal testicular volume, normal secondary sexual characteristics, vas deferens may be absent

54
Q

what are the endocrine features of obstructive male infertility

A

normal LF, FSH and testosterone

55
Q

how should you exam females to investigate infertility

A

BMI, general exam, assessing body hair distribution, galactorrhoea
pelvic exam, assessing for uterine and ovarian abnormalities/tenderness/mobility
swab for chlamydia,
smear if due,
bloods for rubella immunity,
progesterone levels,
test of tubal patency

56
Q

how should you exam males to investigate infertility

A

BMI, general exam, genital exam: assess size/position of testes, penile abnormalities, presence vas deferns, presence varicoceles

semen analysis (twice over 6 weeks apart)

57
Q

why should you check rubella immunity

A

as if women get it when pregnant can affect the baby - cant conceive for a month after being vaccinated as its a live attenuated vaccine

58
Q

how do you test tubal patency

A

laparoscopy or hysterosalpingiogram

59
Q

when is laparoscopy contraindicated to test tubal patency

A

obesity, previous pelvic surgery, crohns

60
Q

when do you do laparoscopy

A

possible tubal/ pelvic disease
known previous pathology (ectopic pregnancy, ruptured appendix, endometriosis)
history suggestive of pathology (dysmenorrhoea, dysparunia),
previous abnormal HSG

61
Q

when is a hysteroscopy

A

only performed in cases where suspected or known endometrial pathology (uterine septum adhesions, polyp)

62
Q

when would a pelvic ultrasound be done

A

when abnormality or pelvic examination

when required for other investigations

63
Q

what endocrine test are done if there is anovulatory cycle or infrequent periods

A 
urine HCG
prolactin 
TSH
testosterone and SHBG
LH 
FSH 
oestradiol
64
Q

what is SHBG

A

sex hormone binding globulin

65
Q

what endocrine test are done if hirsute

A

testosterone and SHBG

66
Q

what tests are done in amenorrhoea

A

endocrine profile and chromosome analysis

67
Q

what is hCG

A

Human chorionic gonadotropin is a hormone produced by the placenta after implantation

68
Q

what are the semen parameters

A

volume, pH, concentration, motility, morphology, WBC

69
Q

what tests are done is there is abnormal semen analysis

A

LH and FSH,
testosterone,
prolactin,
thyroid function

70
Q

what tests are done if there is severely abnormal semen analysis/ azoospermic (no sperm)

A

endocrine profile (as in abnormal semen),
chromosome analysis and Y chromosome microdeletions,
screen for cystic fibrosis,
testicular biopsy

71
Q

what test are done if there is an abnormal male genital exam

A

scrotal ultrasound

72
Q

what causes the symptoms of menopause/ premature ovarian failure

A

decreased oestrogen level - hair thinning, atrophic vaginitis, hot flushes, mood swings

73
Q

what are hormones like in premature ovarian failure

A

abnormally high FSH, LH will be raised

these are due to low oestrogen levels

74
Q

what hormone test can indicate ovarian failure

A

level of FSH more than 30 units/litre on separate occasions (normal is 2-8 units/litre)

75
Q

true or false- oestrogen protects from ischaemic heart disease

A

yes

76
Q

what is the treatment for premature ovarian failure

A

HRT
prevents osteoporosis and coronary heart disease
symptomatic control

77
Q

why is HRT usually combined

A

as progesterone protected the endomterium from getting endometrial cancer whos risk is increased by oestrogen

78
Q

how are eggs donated

A

donor gets stimulation injections of gonadotrophins which cause the growth of follicles
donor eggs retrieved in theatres then ‘matched’ to recipients
transferred into recipients womb

Endocrinology (46 decks)

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