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GK F3E5 > Infertility > Flashcards

Infertility Flashcards

1
Q

What is primary infertility?

A

refers to couples who have not become pregnant after at least 1 year having sex without using birth control methods.

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2
Q

What is secondary infertility?

A

refers to couples who have been able to get pregnant at least once, but now are unable

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3
Q

Women 35 y/o and older are considered infertile if they have tried having sex for how many months w/o birth control?

A

6 months

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4
Q

the probability of being pregnant in a single menstrual cycle

A

Fecundability

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5
Q

T/F

  • Infertility has NO association w/ race or ethnicity
A

True

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6
Q

What % of infertility is due to:

Female?

Male?

Other?

A
  • Female: 65%
  • Male: 20%
  • Other: 15%
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7
Q

In which group of women would you consider discussing fertility w/ oocyte cryopreservation?

A

WWE (women w/ epilepsy)?

*No idea if this is the meaning of the acronym guys…

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8
Q

What recommendations would you give to prevent infertility to a couple? (4)

A
  • Avoid weight extremes –> anovulation
  • Stop using tobacco/recreational drugs
  • ↓ alcohol consumption
  • Avoid scrotal hyperthermia
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9
Q

An infertility evaluation can be performed by which 4 providers?

A
  • Primary care providers
  • OB/GYN providers
  • Fertility specialists
  • Reproductive endocrinologists
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10
Q

What are the top 3 etiologies of the “female factor” associated w/ infertility?

A
  1. Ovulatory disorders (25%)
  2. Endometriosis (15%)
  3. Pelvic adhesions (12%) –> (such as PID)
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11
Q

Ovulatory disorders are responsible for 25% of the female factor of infertility.

What are the 3 types of ovulatory disorders?

A
  • Hypothalamic-pituitary failure (low body weight + excessive exercise)
  • HPO axis dysfunction (PCOS, Hyperprolactinemia)
  • Ovarian failure
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12
Q

What are the top 3 etiologies of “male factors” leading to infertility?

A
  1. Testicular defects in spermatogenesis (65-80%)
  2. Idiopathic (20%)
  3. Sperm transport disorders (5%)
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13
Q

Evaluation of infertility should be initiated earlier if risk of what 3 conditions??

A
  • Premature ovarian failure
  • Severe Endometriosis
  • Known/suspected uterine or tubal dz
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14
Q

What are the 4 key aspects of fertility?

A
  • Sperm
  • Oocyte
  • Transport
  • Implantation
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15
Q

What labs should be evaluated? (8)

A

hCG, TSH, PRL, total Testosterone, DHEA-S, FSH, LH, estradiol

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16
Q

4 key physical exam components of female for infertility

A

•Thyroid exam

  • Assess cervix
  • Assess for uterine abnormalities
  • Assess for adnexal masses

“TUCA”

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17
Q

What hormone level should be checked on day 21 to evaluate for ovulation issues?

Which phase is this?

A

Serum LH surge (Luteal Phase)

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18
Q

What 2 disorders should be evaluated for if pt is “anovulatory?”

A
  • Thyroid
  • Hyperprolactinemia
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19
Q

What hormone level should be evaluated on day 3?

What levels (high or low) would this indicate?

A
  • FSH & Estradiol
  • ↑ FSH and ↓ Estradiol = ovarian failure
  • ↓ or normal FSH and ↓ Estradiol = Hypothalamic Pituitary Failure
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20
Q

How is “Ovarian Reserve” assessed? (3)

A
  • U/S for follicular antral follicle count
  • Antimullerian hormone
  • Clomiphene challenge test
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21
Q

What 2 tests for a female can be therapeutic?

A
  • Hysterosalpingography
  • Laparoscopy / Hysteroscopy
22
Q

What test is performed to evaluate for:

  • Endometriosis
  • Prior pelvic infection
  • Prior ectopic pregnancy
A

Laparoscopy / Hysteroscopy w/ dye

23
Q

What would a PE finding be on a male physical exam significant for infertility?

A

Decreased frequency of shaving (↓ testosterone levels)

24
Q

What are normal results of a semen analysis?

A

Count: 20 million/mL +

Motility: >50%

Morphology: WHO criteria: >30% normal

Kruger Strict Criteria: >14% normal

25
Q

4 labs for eval of male partner

A
  • Testosterone
  • FSH
  • LH
  • PRL
26
Q

If semen analysis results are abnormal, when should the patient be re-tested?

A

4 or more weeks later

27
Q

If semen count is <5 million / mL, what should be evaluated?

A
  • Endocrine evaluation
  • Possible karyotype
28
Q

If a male partner has low testosterone, what follow up labs should be ordered next?

A

Prolactin

29
Q

What do these lab values indicate in male partner?

  • ↓ Testosterone, ↑ FSH, ↑ LH
A

Primary Hypogonadism

30
Q

What do these lab values indicate in male partner?

  • ↓ Testosterone, ↓ Low FSH, ↓ LH
A

Secondary Hypogonadism

31
Q

What do these lab values indicate in male partner?

  • Normal Testosterone, ↓ sperm count, ↓ LH
A

Possible exogenous steroids

32
Q

Evaluation of what 4 things need to be normal to be diagnosed w/ “unexplained infertility?”

A
  • Normal uterine cavity
  • Bilateral patent tubes
  • Evidence of ovulation
  • Normal semen analysis
33
Q

What is the medication tx of choice for women <36 y/o w/ oligomenorrhea or amenorrhea w/ normal FSH, including PCOS?

A

Clomiphene citrate (Clomid)

34
Q

5 SE of Clomiphene citrate (Clomid)

A
  • Hot flashes
  • Emotional lability
  • Depression
  • Bloating
  • Visual changes
35
Q

What medication is recommended for women w/ hx of estrogen dependent tumors.

What is the MOA?

A

Letrozole (Femara)

  • Aromatase inhibitor
36
Q

Ovulation is induction w/ ______

  • Often used in conjunction w/ IUI (Intrauterine insemination)
  • Human menopausal gonadotropin (hMG) or Recombinant FSH (rFSH)
A

Gonadotropins

37
Q

What are 3 SE of inducing ovulation w/ Gonadotropins?

A
  • Multiple gestation
  • Ovarian hyperstimulation syndrome
  • Incr. risk of ectopic pregnancy
38
Q

A laparoscopy is used for patients w/ endometriosis.

  • What is used for patients w/ recurrent abortions, repeated implantation failure, or distorted endometrial cavity by submucosal leiomyoma?
A

Myomectomy

39
Q

With an IUI, cervical mucous is bypassed and therefore not an issue.

What antibiotic is given empirically with an IUI?

A

Doxycycline

40
Q

What are the 5 types of ART? (Assisted Reproductive Technologies)

A
  1. IUI (intrauterine insemination)
  2. ICSI (intracytoplasmic sperm injection)
  3. IVF (in vitro fertilization)
  4. GIFT (gamete intrafallopian transfer)
  5. ZIFT (zygote intrafallopian transfer)
41
Q

Describe IUI and the indication to do this?

A

Sperm is washed to remove prostaglandins, bacteria, & proteins.

Sperm transcervically injected into uterus

  • Indication: mild-moderate male factor infertility
  • Preg rate: 10-20%
  • Cost: $350-500/attempt
42
Q

What method is indicated for severe male factor infertility?

  • It is used in conjunction w/ what female method?
  • Preg rate?
  • Cost?
A

Intracytoplasmic Sperm Injection

  • Used in conjunction w/ IVF
  • Sperm individually injected into each oocyte

Preg rate: 20%

Cost: $1500-3000

43
Q

IVF

  • Follicle development is monitored via US and Estradiol levels
  • When follicles mature, ovulation is triggered
  • How and when are oocytes retrieved from follicles?
A

Oocytes are retrieved from follicles before ovulation by US guided transvaginal aspiration of follicular fluid

44
Q

IVF

  • When are embryos transferred into uterine cavity through the cervix after the retrieval of the occytes?
A

On day 3-5

45
Q

What hormone is supplemented thru 10 weeks gestation if conception occurs with IVF?

A

Progesterone

46
Q

What is the preg rate and cost of IVF?

A

Rate: 20%

Cost: 10k-15k (30k/delivery)

47
Q

Which method?

  • Egg and sperm placed in fallopian tube
  • Fertilization occurs in the body
  • Requires laparoscopy
  • Pregnancy rate: 25%
  • Cost: $15,000-20,000 per attempt
A

GIFT: gamete intrafallopian transfer

48
Q

Which method?

  • Zygote placed into fallopian tube
  • Fertilization occurs in vitro
  • ‘Natural’ implantation into uterus
  • Requires laparoscopy
  • Pregnancy rate: 30%
  • Cost: $10,000-20,000 per attempt
A

ZIFT: zygote intrafallopian transfer

49
Q

3 “other options”

A
  • Donor oocytes
  • Donor sperm
  • Surrogacy – own egg/sperm implanted into another woman for carrying (State specific and expensive)
50
Q

What is the prognosis of infertility w/ unidentified etiology?

A

60% achieve pregnancy within 3 yrs in ABSENCE of tx

51
Q

How many cycles of Clomiphene citrate can be given at MAXIMUM?

A

6

GK F3E5 (19 decks)

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