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Reproductive system > Infertility > Flashcards

Infertility Flashcards

1
Q

How is infertility defined?

A

Inability to conceive after 12 months of regular intercourse with no use of contraception

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2
Q

Should people having fertility problems be seen alone or with their partner and why?

A

With their partner because decisions made will impact both patients

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3
Q

What are the chances of conception?

A

80% of the general population will conceive within one year and of those who do not conceive within one year half will do so in the second year

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4
Q

What are important factors to consider for infertility?

A

Are eggs available?
Are sperm available?
Can they meet?
Can embryo implant?

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5
Q

What questions should be asked of women who are concerned about infertility?

A 
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
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6
Q

What aspects should be examined in female patients?

A 
Weight
Height
BMI
Fat and hair distribution
Galactorrhoea
Abdo examination
Pelvic examination
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7
Q

What is hirsutism?

A

Growth of body hair in women where it wouldn’t normally be expected to grow ie chest hair

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8
Q

What are common causes of hirsutism?

A

Androgen-secreting tumours

Ovarian hyperthecosis

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9
Q

What is acanthosis nigricans?

A

Dark discolouration in body folds and creases

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10
Q

What is acanthosis nigricans a sign of?

A

Androgen excess

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11
Q

What should be felt for in pelvic examination?

A 
Masses
Pelvic distortion
Tenderness
Vaginal septum
Cervical abnormalities
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12
Q

What symptoms might a woman with fibroids experience?

A

Pressure symptoms
Period problems
Infertility

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13
Q

What are baseline investigations if a woman presents with infertility concerns?

A 
Rubella immunity
Chlamydia
TSH
Mid luteal progesterone if periods are regular
Semen analysis of male partner
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14
Q

What investigations can be done at the fertility clinic?

A 
Pelvic ultrasound
Physical examination
Testing for ovulation
Semen analysis repeat if required
Tubal patency test
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15
Q

How is ovulation assessed?

A

In women with regular periods - blood test to measure mid-luteal serum progesterone
Irregular periods should be offered a blood test to measure serum gonadotrophins

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16
Q

What is done to assess for structural abnormalities of the uterus and tubes?

A

Hysterosalpingography - HSG

17
Q

What questions should be asked of male patients concerned about infertility?

A 
Testicular descent
Change in shaving frequency
Loss of body hair
History of mumps
STDs
Surgical history - varicocele repair or vasectomy
Previous fertility
Alcohol, smoking
Chemotherapy
Radiation
Libido
Frequency of intercourse
Any chronic illness
18
Q

What should be done on examination of a male patient?

A 
Weight
Height
BMI
Fat and hair distribution
Abdominal and inguinal examination
Genital examination - epididymis, testes, vas deferens, varicocele
19
Q

What is a varicocele?

A

Dilatation of pampiniform plexus of the spermatic veins in the scrotum

20
Q

What is klinefelter syndrome?

A

Primary hypogonadism caused by XXY chromosome - patients normally have very small testes

21
Q

What are the three groups of ovulatory disorder?

A

Group I - hypothalamic pituitary failue
Group II - hypothalamic-pituitary-ovarian dysfunction
Group III - ovarian faiure

22
Q

How can women with group I ovulatory disorders improve chance of regular ovulation?

A

Increasing body weight if they have a BMI<19
Moderate exercise if undertaking high levels of exercise
Offer pulsatile administration of gonadotrophin releasing hormone

23
Q

What are signs and symptoms of PCOS?

A

Androgen excess
Infrequent periods
Polycystic ovaries

24
Q

What are general methods to improve ovulatory disorders?

A

Treat underlying causes
Weight loss/gain to keep BMI between 18 and 35
Ovulation induction with clomifene or gonadotrophins

25
Q

How should a women with hydrosalpinges be treated?

A

Surgery - salpingectomy

26
Q

What is azoospermia?

A

Semen production with no sperm in it

27
Q

What are investigations for azoospermia?

A

History and examination
FSH,LH,testosterone
Cystic fibrosis screen

28
Q

What is the lowest normal level of semen volume in men?

A

1.5ml

29
Q

What is the lowest normal sperm concentration?

A

15 million/ml

30
Q

What is the lowest normal total sperm number?

A

39 million

31
Q

What is the lowest normal percentage of morphologically normal sperm?

A

4%

32
Q

How should women with unexplained fertility be managed?

A

Advise them to try for 2 years
Inform that clomifene as a stand-alone trearment doesn’t increase chances of pregnancy or live birth
Offer IVF after 2 years

33
Q

What happens in IVF?

A

Eggs are harvested from the ovary
Eggs are fertilised in the lab with sperm
Embryos undergo cell divisions
Embryos transferred to womb

Reproductive system (26 decks)

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