Infertility Flashcards
What is the definition of infertility?
An inability of a couple to conceive after 12 months of regular intercourse without use of contraception
What questions should be considered for a female history regarding infertility?
Duration of infertility Previous contraception Fertility in previous relationships Previous pregnancies and complications Menstrual history Medical and surgical history Sexual history Previous investigations Psychological assessment
In what different ways can androgen be measured?
Testosterone levels Dehydroepiandrosterone sulphate CT to look for adrenal tumour Ferriman Gallwey Score-measures body hair and acne Progesterone level Acanthosis Nigricans
What blood test is done to test if a woman is ovulating?
Serum progesterone
Irregular periods- serum FSH and LH
What tests can be done to measure tubal patency?
Hysterosalpingography
HyCoSy
Laparoscopy dye test
What syndrome has an effect on testicular function and spermatogenesis?
Klinefelter syndrome
How does Cystic Fibrosis affect the male reproductive organs?
Can cause congenital absence of the vas deferens
What are the three groups of ovulation disorders?
Group I: hypothalamic pituitary failure (hypothalamic amenorrhoea or hypogonadotrophic hypogonadism).
Group II: hypothalamic-pituitary-ovarian dysfunction (predominately polycystic ovary syndrome).
Group III: ovarian failure (POI).
What disorders are classed into Group 1 of ovulation disorders?
Low body weight, stress or exercise-related amenorrhoea
Craniopharyngioma or other tumours affecting the hypothalamus
Amenorrhoea combined with anosmia - Kallmann’s syndrome
Idiopathic
What drugs can be given to women with a Group 1 ovulation disorder?
Pulsatile administration of gonadotrophin-releasing hormone or gonadotrophins with luteinising hormone activity to induce ovulation
What are the symptoms of PCOS?
Irregular Menses Hirsutism Infertility Acne Overweight or obesity Hypertension Scalp hair loss Oily skin or excessive sweating Acanthosis nigricans Need two of excess androgen (testosterone or hirsutism), irregular periods or polycystic ovaries on scan
What are the risk factors for PCOS?
Women of reproductive age (symptoms can be masked if on contraception)
FH of PCOS
Premature Adrenarche
Obesity
What is the appearance of PCOS on US?
Multifollicular appearance with 12 or more antral follicles of 2 to 9 mm per ovary and/or ovarian volume >10 cm3
What is the management for PCOS?
Weight loss (can be aided with metformin)
Clomifene (can add dexamethasone)
Gonadatrophins
OCP
What investigations should be done for PCOS?
Serum total and free testosterone Serum dehydroepiandrosterone sulfate (DHEAS) Serum 17-hydroxyprogesterone Serum prolactin Serum thyroid-stimulating hormone Oral glucose tolerance test Fasting lipid panel Pelvic US Serum FSH and LH
