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Repro > Infertility > Flashcards

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

A

TB, Mumps

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

A

15ml

25
Q

Which syndrome is a common cause of primary hypodngrogenism with impaired spermatogenesis and testosterone deficiency?

A

Klinefelter Syndrome

26
Q

What is the most common sex chromosome aneuploidy associated with small testes and azoospermia seen in Klinefelters?

A

Extra X XXY

27
Q

Two conditions affecting Vas Deferens

A

Cystic Fibrosis

Congenital bilateral absence of Vas Deferens (CBAVD)

28
Q

Describe the WHO Ovulatory Disorder Classfication Groups

A

Group I - Hypothalamic Pituitary Failure
Group II - Hypothalamic-Pituitary-Ovarian Dysfunction (eg PCOS)
Group III- Ovarian failure (Primary Ovarian Insufficiency)

29
Q

How can chance of ovulation/conception etc be improved within Group I with Ovulatory Disorder?

A

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
Q

3 Features to be diagnosed with PCOS

A

Clinical or Biochemical androgen excess
Infrequent periods - anovulation
Polycystic ovaries

31
Q

Ovulation induction can be achieved with what 3 treatments

A

Clomifene
Gonadotrophins
GnRH

32
Q

How does clomifene induce ovulation?

A

Blocks oestrogen receptors in anterior pituitary - increases FSH secretion

33
Q

How is clomifene therapy monitored>

A

Follicle scanning in 1st cycle

34
Q

Dose of clomifene therapy

A

50-150 mg in Days 2-5

35
Q

Side effects of clomifene therapy

A

Vasomotor

Visual

36
Q

Disadvantage of Gonadotrophin therapy

A

Multifollicular recruitment

37
Q

What are the possible consequences of multifollicular recruitment seen in Gonadotrophin therapy

A

Multiple pregnancy risk

Ovarian Hyperstimulation Syndrome

38
Q

Symptoms of Ovarian Hyperstimulation Syndrome

A

Abdominal bloating
Nausea
Diarrhoea
Tenderness

39
Q

Dangers of Ovarian Hyperstimulation Syndrome

A

Ruptures of cyst -> fatal bleed
Breathlessness
Termination/loss of pregnancy

40
Q

Risk of Polycystic Ovaries under Gonadotrophin therapy

A

May remain quiescent until dose threshold reached and proceed to repsond excessively

41
Q

Management if infertility attributed to tubal factor or endometriosis

A

Surgery
Reversal of sterilisation
IVF

42
Q

Management if infertility attributed to male factor

A 
Urologist referral if appropriate
IVF/ ICSI
Intrauterine insemination
Surgery - reverse vasectomy, surgical sperm retrieval
Donor insemination
43
Q

Investigation for azoospermia

A 
History
Examination
FSH, LH, Testosterone, Karyotype, PRL
CF screen
Surgica sperm retrieval
44
Q

2 Methods of surgical sperm retrieval

A

Micro-epididymal sperm aspiration

Testicular sperm extraction

45
Q

Management of Unexplained Infertility

A

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
Q

Stages of IVF

A

Intracytoplasmic Sperm Injection (ICSI)- injection of mature egg with single sperm, incubate ovenight
Fertilisation to embryo
Embryo transfer
Cryopreservation

47
Q

Factors increasing IVF use

A

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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