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Gynaecology > Infertility > Flashcards

Infertility Flashcards

1
Q

Define infertility.

A

Failure to conceive after 1 yr of unprotected sex

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2
Q

What questions do you ask yourself about infertility?

A

is it the man?
is it the ovulation?
is it the tubes?
is it something else?

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3
Q

What percent of infertility is down to the man?

A

30%

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4
Q

What percent of infertility is down to the ovulation?

A

25% (anovulatory)

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5
Q

Tell me about how sperm is made.

A

FSH/LH — leydig — testosterone – sertoli — sperm

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6
Q

Idiopathic male infertility is common. True or false?

A

true

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7
Q

Name 4 drugs that can cause male infertility.

A

alcohol, smoking, steroids, industrial chemicals

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8
Q

Name 5 causes of male infertility other than idiopathic or drugs.

A
  • CF
  • Klinefelter’s
  • Kallmans
  • epididymitis
  • retrograde ejaculation
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9
Q

What do you find out about sperm in semen analysis? (x3)

A

sperm count
mobility
morphology

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10
Q

If semen analysis abnormal, what do you do?

A

examine testes

repeat 3 months later

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11
Q

If semen analysis shows azoospermia, what three further tests would you do?

A

KARYOTYPE
CF SCREEN
HORMONE PROFILE

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12
Q

What’s tested in a hormone profile?

A

FSH, LH, TSH, testosterone, prolactin

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13
Q

What is the difference between primary and secondary infertility?

A

primary - has never conceived before

secondary - has conceived before

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14
Q

What % of infertility is down to the tubes?

A

20%

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15
Q

What % of infertility is down to something else?

A

25% unexplained

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16
Q

Give me two examples of conditions that would cause anovulatory infertility.

A

PCOS

premature ovarian failure

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17
Q

If a woman is ovulating, her mid luteal progesterone should be above what??

A

above 30

if it’s below it makes you think anovulatory

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18
Q

To investigate anovulatory infertility, what three investigations?

A

MID LUTEAL PROGESTERONE
HORMONE PROFILE
OVARIAN RESERVE TESTING (day 2 FSH, AMH)

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19
Q

If a woman has low ovarian reserve, what would you expect from ovarian reserve testing?

A

Day 2 FSH low

AMH high

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20
Q

Low AMH =

A 
low eggs
(in premature ovarian failure)
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21
Q

What three things could cause ISHEWS with the tubes causing infertility?

A

PID
endometriosis!!!!
adhesions

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22
Q

What investigations for tubes infertility?

A

HyCoSy
or hysterosalpingogram
or laparoscopy + dye test

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23
Q

What is HyCoSy?

A

hystero salpingo contrast sonography (US)

best option for investigating tubes infertility

24
Q

Why would day 2 FSH be high in anovulatory fertility?

A

the FSH is having to push hard for follicles to make oestrogen but not getting anywhere

25
Q

Name 4 tips and tricks for maximising chances of conceiving.

A

intercourse 3x a week
no smoking / alcohol
healthy BMI + controlled comorbidities
folic acid + vit supplements

26
Q

In what scenario could you get referral for assisted conception before a yr of trying?

A

> 35, Hx pelvic surgery

risk factors basically

27
Q

What is intra-uterine insemination?

A

sperm injected into uterine cavity

28
Q

What is half the price of IVF and half the success rate?

A

intra-uterine insemination

29
Q

sperm injected into cavity. What’s this?

A

intra-uterine insemination.

30
Q

What is success rate of IVF?

A

30-35%

31
Q

How long does one cycle of IVF take?

A

one month

32
Q

Do you need patent tubes for IVF?

A

no

33
Q

Do you need normal ovarian reserve for IVF?

A

yes (for egg collection)

34
Q

Give me the five stages of IVF.

A
  1. stimulate ovaries
  2. egg collection
  3. fertilisation and culture
  4. embryo transfer
  5. luteal phase support.
35
Q

FSH/LH injections in IVF. What stage is this?

A
  1. stimulate ovaries
36
Q

transvaginal needle in IVF… what stage is this?

A
  1. egg collection
37
Q

Growing a blastocyst in IVF… what stage is this?

A
  1. fertilisation and culture
38
Q

Catheter through cervix. What stage of IVF is this?

A
  1. embryo transfer
39
Q

Progesterone until 4-8wks. What stage of IVF is this?

A
  1. luteal phase support
40
Q

After stimulating the ovaries, what is the next step in IVF?

A
  1. egg collection
41
Q

After egg collection, what is the next step in IVF?

A
  1. fertilisation and culture
42
Q

After fertilisation and culture, what is the next step in IVF?

A
  1. embryo transfer
43
Q

After embryo transfer, what is the next step in IVF?

A
  1. luteal phase support
44
Q

Give me three RISKS of IVF.

A

multiple pregnancy
ectopic pregnancy
ovarian hyperstimulation syndrome.

45
Q

multiple pregnancy
ectopic pregnancy
and ovarian hyperstimulation syndrome

are all risks of what?

A

IVF

46
Q

What process is an adjunct to IVF?

A

intra-cytoplasmic sperm injection (ICSI)

47
Q

Intra-cytoplasmic sperm injection is on about which cytoplasm?

A

the cytoplasm of the oocyte

injecting sperm right into the egg rather than just mixing them

48
Q

explain what intra-cytoplasmic sperm inject is please.

A

injecting sperm right into the egg rather than just mixing them

an adjunct to IVF

49
Q

Which method of assisted conception is particularly good for male infertility with IMMOTILE sperm?

A

intra-cytoplasmic sperm injection

they can’t swim there themselves

50
Q

Give me 5 indications for Assisted Conception

A 
unexplained infertility
male subfertility
endometriosis
genetic disorders
other methods failed.
51
Q

For those with low ovarian reserve, IVF isn’t suitable. What is?

A

egg donation

52
Q

What happens in egg donation?

A

the donor goes through the stimulation bit of IVF

then the recipient gets the embryo transfer bit!

53
Q

What is straight surrogacy?

A

surrogate’s eggs

54
Q

What is host surrogacy?

A

her eggs

55
Q

What conditions might be candidates for surrogacy?

A

can’t carry in womb:

congenital uterine abnormalities
hysterectomy
chronic disease needing teratogenic drugs!

56
Q

If you’re having chemo which threatens your fertility, and you’re in a relationship, what assisted conception could you consider?

A

embryo freezing

needs partner’s consent to be thawed

Gynaecology (8 decks)

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