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Reproduction & Sexual Health > Infertility > Flashcards

Infertility Flashcards

1
Q

What is the WHO definition of infertility?

A

Failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse (in absence of known reason) in a couple who have never had a child.

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2
Q

What is primary infertility?

A

infertility in a couple who have never conceived.

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3
Q

What is secondary infertility?

A

couple previously conceived, although pregnancy may not have been successful e.g. miscarriage or ectopic

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4
Q

What are some factors with increase the chance of conception?

A 
women <30
previous pregnancy
<3 years trying to conceive
intercourse occurring around ovulation
woman's BMI 18.5-30
both partners non-smokers
<2 cups coffee a day
no recreational drug use
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5
Q

When are the physiological times when a female is infertile due to anovulation?

A

before puberty, pregnancy, lactation, menopause

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6
Q

what levels of FSH, LH and oestrogen would you see in an anorexic patient?

A

low FSH, LH and oestrogen

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7
Q

What levels of FSH, LH and oestrogen would you see in premature ovarian failure?

A

high FSH, high LH, low oestrogen

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8
Q

What are the symptoms of endometriosis?

A 
dysmenorrhoea (classical before menstruation)
dyspareunia 
menorrhagia (heavy)
painful defaecation
chronic pelvic pain
infertility
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9
Q

What are some non-obstructive causes of male infertility?

A 
47 XXY (Kleinfelter's)
chemotherapy
radiotherapy
undescended testes
idiopathic
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10
Q

What are the clinical features of non-obstructive male infertility?

A

low testicular volume
reduces secondary sexual characteristics
vas deferens present

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11
Q

what endocrine profile would you see in non-obstructive infertility?

A

high LH & FSH

low testosterone

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12
Q

What are some causes of obstructive male infertility?

A

congenital absence (cystic fibrosis), infecting, vasectomy

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13
Q

what are the clinical features of obstructive male infertility?

A

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

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14
Q

What endocrine profile would you see in obstructive male infertility?

A

normal LH, FSH and testosterone

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15
Q

What investigations would you do to test a female patient’s fertility?

A

vulvo-vaginal swab (self-taken) or endocervical swab (if speculum examination) for chlamydia
smear if due
midluteal progesterone level
hysterosalpingogram (HSG) - tubal patency

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16
Q

Describe the midluteal progesterone level measurement.

A

Taken on day 21 of a 28-day cycle (or 7 days before expected period in prolonged cycles). If progesterone >30nmol/L then it is suggestive of ovulation.

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17
Q

When is a hysteroscopy performed?

A

only in cases where suspected or known endometrial pathology i.e. uterine septum, adhesions, polyp.

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18
Q

When would you perform a pelvic ultrasound?

A

when abnormality is felt on pelvic examination e.g. enlarged uterus/adnexal mass.
When required from other investigations, e.g. possible polyp seen at HSG

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19
Q

Which hormones/tests would you look for if a female patient had an anovulatory cycle or infrequent periods?

A 
urine HCG
prolactin
TSH
Testosterone and SHBG
LH, FSH and oestrogen
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20
Q

What endocrine tests would you do if a male patient had abnormal semen analysis?

A

LH and FSH
testosterone
PRL
thyroid function

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21
Q

If a male patient had severely abnormal semen analysis/azoospermia, which tests would you do?

A

endocrine profile (as in abnormal semen)
chromosome analysis and Y chromosome micro deletions
screen for CF
testicular biopsy

22
Q

What percentage of weight loss is recommended to overweight women who seek fertility advice?

A

5-10% weight loss

23
Q

What is the typical folic acid recommendation?

A

400mcg daily before pregnancy and throughout the first 12 weeks

24
Q

When would you recommend 5mg folic acid a day?

A

women who are planning a pregnancy / in early stages of pregnancy if they:
(or their partner) have a neural tube defect
have had a previous baby with a neural tube defect
(or their partner) have a FH of neural tube defects
have diabetes

25
Q

What is the recommended amount of vitamin D for pregnant and lactating women?

A

10mcg a day

26
Q

What are the characteristics of rubella infection in a baby?

A 
rash at birth
low birth weight
small head size
heart abnormalities (PDA)
visual problems (cataracts)
bulging fontanelle
27
Q

What kind of disorders would cause hypogonadotropic hypogonadism?

A

Hypothalamic-pituitary failure: any lesion affecting the pituitary or hypothalamus and affecting gonadotrophin production

28
Q

What kind of disorder would cause normo-gonadotrophic hypogonadism?

A

Hypothalamic-pituitary dysfunction - most commonly caused by PCOS

29
Q

What disorder causes hypergonadotropic hypogonadism?

A

ovarian failure

30
Q 
Low FSH/LH
Low oestrogen
Normal PRL 
Amenorrhoea 
-ve progesterone challenge
A

hypothalamic-pituitary failure

e.g. anorexia, stress, pituitary tumours, excessive exercise, Kallman’s syndrome

31
Q

Normal FSH/LH (/excess LH)
Normal oestrogen
Oligo-amenorrhoea

A

hypothalamic-pituitary dysfunction

e.g. PCOS

32
Q

Why might LH be in excess in PCOS?

A

insulin is a con-gonadotrophin to LH

33
Q

High LH/FSH
Low oestrogen
Amenorrhoea

A

Ovarian failure

ovulation induction usually unsuccessful due to follicular depletion

34
Q

Name the 4 types of fibroids.

A

Pedunculated
Subserous
Sub-mucous
Intramural

35
Q

Which fibroid type is unlikely to majorly impact on fertility?

A

subserosal

36
Q

What are the Assisted Conception Treatments available?

A 
Donor insemination
Intra-uterine insemination (IUI)
In vitro fertilisation (IVF)
Intra-cytoplasmic sperm injection (ICSI)
Fertility preservation
Surrogacy
37
Q

what are the indications for intra-uterine insemination?

A

sexual problems
same sex relationships
abandoned IVF

38
Q

Describe the method of intra-uterine insemination (IUI).

A

Natural or stimulated (gonadotrophin injections) cycle

Prepared smeen inserted into uterine cavity around time of ovulation

39
Q

What are the indications for IVF?

A 
Unexplained (>2 year duration)
Pelvic disease (endometriosis, tubal disease, fibroids)
Anovulatory infertility (after failed ovulation induction)
Failed intra-uterine insemination (after 6 cycles)
40
Q

What are the indications for intra-cytoplasmic sperm injection (ICSI)?

A

severe male factor infertility
previous failed fertilisation with IVF
preimplantation genetic diagnosis

41
Q

Describe the process of intra-cytoplasmic sperm injection (ICSI).

A

Each egg is stripped, sperm immobilised, single sperm injected, incubate at 37 degrees overnight.

42
Q

Before ICSI can be carried out, what might have to happen if the male has azoospermia?

A

surgical sperm aspiration - can extract from epididymis (if obstructive) or testicular tissue (non-obstructive)

43
Q

What are the steps of the IVF process?

A 
Down regulation 
Ovarian stimulation 
Oocyte collection (theatre)
Fertilisation
Embryo transfer
44
Q

Describe down regulation: stage 1 IVF.

A

synthetic gonadotrophin hormone analogue / agonist given which allows precise timing of oocyte to be recovered.

45
Q

What are the side effects of the synthetic gonadotrophin used in IVF?

A

hot flushes and mood swings
nasal irritation (spray)
headaches

46
Q

How are the ovaries stimulated in IVF?

A

Gonadotrophin hormone containing either synthetic or urinary FSH ± LH can be self-administer via SC injection.
Causes follicular development.
Stimulation scan done which allows for planning for HCG injection (eases collection of follicles)

47
Q

What size indicates follicles are ready to harvest?

A

18mm

48
Q

How long does the male pattern need to abstain for pre-semen collection for IVF?

A

72 hrs beforehand - use within 1 hr of production

49
Q

What is the semen assessed for prior to IVf use?

A

Volume
Density
Motility
Progression

50
Q

What medication is given after embryo transfer in IVF?

A

luteal support: progesterone suppositories for 2 weeks

Reproduction & Sexual Health (15 decks)

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