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Infertility Flashcards

1
Q

Indication of infertility

A

Inability to conceive after 12 months of regullar intercourse without contraception

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2
Q

4 Queries to investigate infertility

A

Are there eggs available?
Are there sperm available?
Are they able to meet?
Can an embryo implant?

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3
Q

Female Infertility History

A 
Duration of infertility
Previous contraception
Fertility in other relationships
Previous pregnancies, complications
Menstrual history
Medical and surgical history
Sexual history
Previous investigations
Psychological assessment
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4
Q

Female Examination for Infertility

A 
Weight and Height
BMI
Fat and hair distribution
Galactorrhea
Abdominal examination
Pelvic examination
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5
Q

What signs are looked for on pelvic examination?

A 
Masses
Pelvic distortion
Tenderness
Vaginal septum
Cervical abnormalities
Fibroids - Pressure Symptoms (HX period problems, infertility)
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6
Q

Causes of Hirsutism

A

Nonclassic Congenital Adrenal Hyperplasia (NCCAH)
PCOS- Cushings, Acromegaly
Androgen-secreting tumours - ovarian and adrenal
Ovarian hyperthecosis

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7
Q

How is androgen excess/hirsutism scored?

A 
Ferrimen Gallwey Score
Less than 8 no hirsutism
8-15 mild
Up to 25 moderate
Above 25 severe

Areas Mouth, Chin, Chest, Genital
Each area scored 1-4 on hari distribution

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8
Q

Biochemical measurements of androgen excess

A

Testosterone
Dehydroepiandrosterone sulphate (DHEAS)
17 OH Progesterone

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9
Q

Clinical sign of androgen excess

A

Acanthosis nigrans

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10
Q

Baseline Investigations for infertility in female partner

A

Rubella immunisation
Chlamydia
TSH
Mid luteal progesterone - if periods regular (7 days prior to period)
Day 1-5, FSH, LH, PRL, TSH, Testosterone if periods irregular

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11
Q

Baseline investigations for infertility in male partner

A

Semen analysis

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12
Q

Investigations provided at Fertility clinic

A 
Pelvic ultrasound
Physical examination
Testing for ovulation
Semen analysis
Tube patency
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13
Q

What technique is used to assess whether tubes are patent?

A

Hysterosalpingography

Will show occlusion

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14
Q

Under what patient conditions will tubal patency be assessed?

A

No known comorbidities - endometriosis, previous ectopic pregnancy, PID

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15
Q

Male Infertility History

A

Developmental - testicular descent, change in shaving frequency, loss of body hait
Infection - mumps, std
Surgical - varicocele, vasectomy
Previous fertility
Drugs & environmental - alcohol, smoking, steroids, chemo, radiation, recreational drugs
Sexual history - libido, frequency of intercourse, previous fertility assessment
Chronic illness

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16
Q

Male examination

A 
Weight
Height
BMI
Fat and hair distribution
Abdominal and inguinal examination
Genital examination
- Epididymis, Testes, Vas deferens, Varicocele
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17
Q

Male symptoms of androgen insufficiency

A

Increased body fat
Decreased muscle mass
Loss of pubic, facial and axillary hair

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18
Q

Epididymitis is associated with which STDs

A

Chlamydia

Gonorrhea

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19
Q

Effects of epididymitis

A

Seminiferous tubular necrosis

Disrupts spermatogenesis

20
Q

Epididymitis is seen in which conditions

21
Q

Varicocele is the dilation of which veins in the scrotum

A

Pampiniform plexus of spermatic veins

22
Q

Signs in men with presumptive infertility and varicocele

A

Abnormal semen parameters

Low sperm concentration

23
Q

What should be identified on testicular examination

A

Cysts, tumour, volume

24
Q

Below which volume is testicular volume considered small

25
Which syndrome is a common cause of primary hypodngrogenism with impaired spermatogenesis and testosterone deficiency?
Klinefelter Syndrome
26
What is the most common sex chromosome aneuploidy associated with small testes and azoospermia seen in Klinefelters?
Extra X XXY
27
Two conditions affecting Vas Deferens
Cystic Fibrosis | Congenital bilateral absence of Vas Deferens (CBAVD)
28
Describe the WHO Ovulatory Disorder Classfication Groups
Group I - Hypothalamic Pituitary Failure Group II - Hypothalamic-Pituitary-Ovarian Dysfunction (eg PCOS) Group III- Ovarian failure (Primary Ovarian Insufficiency)
29
How can chance of ovulation/conception etc be improved within Group I with Ovulatory Disorder?
Increase body weight if BMI of 19 or less Moderate exercise levels if high Pulsatile admin of GnRH or gonadotrophins with lutenising hormone activity
30
3 Features to be diagnosed with PCOS
Clinical or Biochemical androgen excess Infrequent periods - anovulation Polycystic ovaries
31
Ovulation induction can be achieved with what 3 treatments
Clomifene Gonadotrophins GnRH
32
How does clomifene induce ovulation?
Blocks oestrogen receptors in anterior pituitary - increases FSH secretion
33
How is clomifene therapy monitored>
Follicle scanning in 1st cycle
34
Dose of clomifene therapy
50-150 mg in Days 2-5
35
Side effects of clomifene therapy
Vasomotor | Visual
36
Disadvantage of Gonadotrophin therapy
Multifollicular recruitment
37
What are the possible consequences of multifollicular recruitment seen in Gonadotrophin therapy
Multiple pregnancy risk | Ovarian Hyperstimulation Syndrome
38
Symptoms of Ovarian Hyperstimulation Syndrome
Abdominal bloating Nausea Diarrhoea Tenderness
39
Dangers of Ovarian Hyperstimulation Syndrome
Ruptures of cyst -> fatal bleed Breathlessness Termination/loss of pregnancy
40
Risk of Polycystic Ovaries under Gonadotrophin therapy
May remain quiescent until dose threshold reached and proceed to repsond excessively
41
Management if infertility attributed to tubal factor or endometriosis
Surgery Reversal of sterilisation IVF
42
Management if infertility attributed to male factor
``` Urologist referral if appropriate IVF/ ICSI Intrauterine insemination Surgery - reverse vasectomy, surgical sperm retrieval Donor insemination ```
43
Investigation for azoospermia
``` History Examination FSH, LH, Testosterone, Karyotype, PRL CF screen Surgica sperm retrieval ```
44
2 Methods of surgical sperm retrieval
Micro-epididymal sperm aspiration | Testicular sperm extraction
45
Management of Unexplained Infertility
Consider age Previous pregnancy Duration of infertility Do not offer oral ovarian stimulation agents ie clomifene to women with unexplained infertility Advise unprotected regular intercourse for 2 years before considering IVF
46
Stages of IVF
Intracytoplasmic Sperm Injection (ICSI)- injection of mature egg with single sperm, incubate ovenight Fertilisation to embryo Embryo transfer Cryopreservation
47
Factors increasing IVF use
Female age - increasing age decreases likelihood of live birth Change in society - single women, same sex couples, obesity, older women wanting to conceive Method of Fertility preservation

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