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J Repro > Infertility > Flashcards

Infertility Flashcards

1
Q

how many couple present with infertility

A

1 in 6 couples

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2
Q

why is infertility increasing in incidence (3)

A

increasing paternal age
chlamydia
more same sex couples

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3
Q

infertility definition

A

failure to achieve pregnancy after 12 months of regular unprotected sex in a couple who have never had a child

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4
Q

what is the difference between primary and secondary infertility

A

primary infertility - couple never conceived

secondary infertility - couple who have conceived but pregnancy unsuccessful (miscarriage or ectopic)

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5
Q

hypothalamic causes of hypogonadotropic hypogonadism = causing infertility (4)

A

anorexia/excessive exercise
kallmans syndrome
stress
drugs

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6
Q

pituitary causes of hypogonadotropic hypogonadism = causing infertility (3)

A

hyperprolactinaemia
sheehans syndrome (hypopituitarism cause by hypovolaemic shock after PPH)
pituitary tumours

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7
Q

ovarian causes of infertility (3)

A

PCOS
POF
endometriosis

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8
Q

tubal causes of infertility (3)

A

chlamydia - causes PID
hydrosalpinx - fluid dilatation of fallopian tubes
endometriosis - narrows tube

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9
Q

4 potential areas of problem causing infertility in women

A

hypothalamus
pituitary
ovaries
fallopian tubes

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10
Q

apart from drugs and idiopathic causes, where can the problem be in men with infertility (3)

A

pre testicular
testicular
post testicular (obstructive)

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11
Q

causes of pretesticular infertility (4)

A

pituitary problem = hyperprolactinaemia
kallmans syndrome
anorexia
steroid abuse

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12
Q

testicular causes of infertility (4)

A

kleinfelters syndrome (XXY) = testicular failure
varicocele
cryptorchidism (undescended testes)
chemo/radio

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13
Q

post testicular (obstructive) causes of infertility

A

ejaculatory gland obstruction
erectile dysfunction
vasectomy
absence of vas deferens (cystic fibrosis)

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14
Q

investigations for female infertility

A

chlamydia screen - endocervical swab
baseline hormone profile (menstruation cycles)
pelvic exam/US (for PCOS/abnormal growths)
tubal patency tests - hysterosalphingogram (HSG)

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15
Q

what is a hysteroslaphingogram (HSG)

A

contrast inserted into uterine cavity + xray takento look at patency of fallopian tube s(fluid should leak out into peritoneal cavity

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16
Q

investigations for male infertility

A 
chlamydia screen - first pass urine sample 
testes size (compare to beads)
semen analysis (sperm count)
17
Q

normal size of testes

A

12-25ml

18
Q

what is azoospermia

A

no sperm

19
Q

what are you looking for in semen analysis

A 
semen volume 
sperm concentration 
sperm morphology 
WBC 
sperm motility
20
Q

how long must a male abstain for before a semen analysis

A

abstain from sex for 3 days

21
Q

if semen analysis is abnormal what do you do

A

endocrine profile - LH, FHS, testosterone, prolactin, TFTs

22
Q

what is oligoasthenospermia

A

low count and low mobility sperm

23
Q

what is teratoosthenospermia

A

low count and abnormal form of sperm

24
Q

first line treatment for infertility

how many people is this effective for

A

lifestyle advice!!

increase sexual intercourse - for 6 days before ovulation 
lose/gain weight (BMI 18.5-30)
stop smoking 
reduce alcohol 
reduce coffee

effective for half of infertile people!

25
Q

second line treatment (if lifestyle modification doesn’t work) for male infertility (3)

A

donor sperm
intrauterine sperm insemination
intracytoplasmic sperm injection

26
Q

what can you give a male with infertility caused by hyperprolactinaemia

A

cabergoline

27
Q

when would you used intrauterine sperm insemination/intracytoplasmic sperm injection

A

failed IVF

28
Q

difference between intrauterine sperm insemination and intracytoplasmic sperm injection

A

IUSI - sperm inserted into uterus

ICSI - sperm injected straight into egg, then into uterus?

29
Q

usually males can ejaculate their own sperm used for IUSI/ICSI, what are the alternatives if they cant (2)

A

surgical sperm aspiration

donor sperm

30
Q

second line treatment (if lifestyle modification doesn’t work) for female infertility (4)

A

IVF
surrogacy - another female carries baby
egg donation
HRT

31
Q

which hormone is used to assess ovarian reserve prior to IVF

A

anti Mullerian hormone (AMH)

32
Q

IVF process (3)

A

semen and egg both collected
egg fertilization in lab
embryo implanted in uterus

33
Q

when can you use HRT for infertility

A

if hypothalamic/pituitary problem (not if ovarian/tubal problem)

34
Q

which hormones can be give in HRT for infertility

A

GnRH
LH and FSH

dependent on if problem is hypothalamic/pituitary

35
Q

complications of HRT

A

ovarian hyperstimulation syndrome (OHSS) = swollen - ascites

36
Q

what is a heterotopic pregnancy

when is there an increased risk for this

A

2 pregnancies - 1 in uterus 1 ectopic

IVF risk factor

J Repro (28 decks)

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