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Endocrine: Reproductive Glands > Infertility > Flashcards

Infertility Flashcards

1
Q

define infertility

A

failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse in a couple who have never had a child

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2
Q

two types of infertility

A 
primary= couple who have never conceived
secondary= previously conceived but not successful e.g. miscarriage or ectopic pregnancy
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3
Q

factors that increase the chance of conception

A 
under 30
previous pregnancy
less than 3 years trying to conceive
sex around ovulation
healthy BMI
non-smoker (both)
caffeine intake less than 2 cups of coffee daily
no illicit drugs
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4
Q

physiological causes of anovulatory infertility

A

before puberty
pregnancy
lactation
menopause

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5
Q

gynaecological causes of anovulatory infertility

A
  • hypothalamic= anorexia/bulimia (low FSH, LH and oestradiol), excessive exercise
  • pituitary= hyperprolactinaemia, tumours and Sheehan syndrome
  • Ovarian= PCOS, premature ovarian failure
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6
Q

other causes of anovulatory infertility

A 
systemic= chronic renal failure
endocrine= testosterone secreting tumours, CAH, hypothyroid
drugs= depoprovera, explain and OCP
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7
Q

infective causes of tubal disease

A 
PID (chlamydia, gonorrhoea, anaerobes, syphilis, TB)
transperitoneal spread (appendicitis, intra-abdominal abscess)
after procedure (IUCD insert, hysteroscopy and HSG)
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8
Q

non-infective causes of tubal disease

A 
endometriosis
surgical (sterilisation, ectopic pregnancy)
fibroids
polyps
congenital
salpingitis isthmica nodosa
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9
Q

define hydrosalpinx

A

condition where the fallopian tube is blocked and filled with serous/clear fluid near the ovary

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10
Q

presentation of hydrosalpinx

A 
abdominal/pelvic pain
febrile
vaginal discharge dyspareunia
cervical excitation menorrhagia
dysmenorrhoea
infertility
ectopic pregnancy
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11
Q

what is the management in tubal disease

A

surgical

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12
Q

proximal obstruction surgery in tubal disease

A

salpinography plus tubal catheterisation or hysteroscopic tubal cannulation

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13
Q

management of hydrosalpinges

A

salpingectomy by laparoscopy

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14
Q

what does success of the operation depend on?

A

amount of healthy tube

presence of adhesions

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15
Q

define endometriosis

A

presence of endometrial glands outside uterine cavity

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16
Q

causes of endometriosis

A

genetic
retrograde menstruation
altered immune function
abnormal cellular adhesion molecules

17
Q

presentation of endometriosis

A 
dysmenorrhoea (classically before menstruation)
dyspareunia
menorrhagia
painful defaecation
chronic pelvic pain
18
Q

diagnosis of endometriosis

A

chocolate cysts on ovary

19
Q

management of endometriosis

A

removal of cysts can be ablation, resection, adhesiolysis and cystectomy

20
Q

types of fibroids

A

pedunculated
sub mucous (hyperoscopically)
intramural
subserous (no management)

21
Q

investigations for infertility

A
  • history, examination, BMI, genital/pelvic examination

- tubal patency

22
Q

how to assess tubal patency?

A

laparascopy

hysterosalpingogram (use if laparoscopy contraindicated in obesity, previous pelvic surgery or Crohn’s)

23
Q

when should laparoscopy be used?

A 
possible PID
previous pathology (ectopic pregnancy, ruptured appendix and endometriosis) or previous abnormal HSG
24
Q

when should hysteroscopy be used?

A

known/suspected endometrial pathology e.g. uterine septum (metroplasty), adhesions/polyps

25
Q

when should USS be used

A

abnormality on pelvic examination

26
Q

endocrine investigations in infertility

A

anovulatory/infrequent periods= HCG, prolactin, TSH, testosterone, SHBG, LH, FSH and oestradiol
hirsute= testosterone and SHBG
amenorrhoea= endocrine and chromosome analysis

27
Q

non-obstructive causes of male infertility

A 
47XXY
chemotherapy 
radiotherapy
undescended testes
idiopathic
28
Q

presentation of non-obstructive male infertility

A

low testicular volume

reduced secondary sexual characteristics with vas deferens present

29
Q

diagnosis of non-obstructive male infertility (biochemically)

A

high LH/FSH

low testosterone

30
Q

causes of obstructive male infertility

A

congenital (CF)
infection
vasectomy

31
Q

presentation of obstructive male infertility

A

normal testicular volume
normal secondary sexual characteristics
vas deferens may be absent

32
Q

diagnosis of obstructive male infertility (biochemically)

A

normal LH, FSH and testosterone

33
Q

investigations for male infertility

A 
semen analysis (twice over 6 weeks apart)
hormones
chromosome analysis
CF screening
testicular biopsy
scrotal USS
34
Q

who should have 5mg a day of folic acid if they are planning/in early stages of pregnancy?

A

diabetics
they or their partner has a neural tube defect
previous baby with neural tube defects
FH of neural tube defects

Endocrine: Reproductive Glands (6 decks)

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