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BRS Y2 > Infertility > Flashcards

Infertility Flashcards

1
Q

What is infertility?

A

A disease of the reproductive system defined by the failure to achieve a clinical pregnancy after ≥12 months of regular unprotected sexual intercourse

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2
Q

What is primary infertility?

A

When you have not had a live birth previously

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3
Q

What is secondary infertility?

A

When there has been a live birth in the past 12 months

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4
Q

What are the impacts of infertility on couples?

A

Psycological:

no child, family, treatement impact

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5
Q

What are the impacts of infertility on society?

A

Less births
Less tax income
Treatment costs

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6
Q

What are pre testicular causes of infertility in males?

A

Congenital or accquired eg Klinefeters, Y chromsome loss

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7
Q

What are testicular causes of infertility in males?

A

Congenital, STD/infections, immunological, vascular, trauma, toxins

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8
Q

What are post testicular causes of infertility in males?

A

Congenital, obstructive azoospermia, erectile dysfunction, latrogenic

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9
Q

What is cryptochidism?

A

Undescended testes (should be through inguinal canal)

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10
Q

What are causes of infertility in females?

A

Ovarian causes- anovulation, corpus luteum insufficiency
Tubal causes- tubopathy due to infection, trauma, endometriosis
Uterine causes- endometriosis, fibroid, adhesions
Cervical causes- ineffective sperm penetration sue to chronic cervicitis or immunological

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11
Q

What is endometriosis?

A

Presence of functioning endometrial tissue outside the uterus
(responds to oestrogen)

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12
Q

What are symptoms of endometriosis?

A

Menstrual pain
Pain on intercourse
Menstrual irregularities
Infertility

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13
Q

How is endomertriosis treated?

A

Hormonal
Laparascopic ablation
Hysterectomy
Bilateral Salpingo-oophorectomy

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14
Q

What are fibroids in infertile women?

A

Benign tumours of the myometrium

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15
Q

What are symptoms of fibroids?

A 
Usually asymptomatic
↑ Menstrual pain
Menstrual irregularities
Deep dyspareunia
Infertility
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16
Q

How are fibroids treated?

A

Hormones

Hysterectomy

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17
Q

What are LH, FSH and testosterone levels in a male with hyperprolactinemia?

A

LH-low
FSH-low
Testosterone-low

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18
Q

What are LH, FSH and testosterone levels in a male with Klinefelters (primary testicular failure)?

A

LH- high
FSH-high
Testosterone-low

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19
Q

What male infertility problems arise due to hypothalamus problems?

A

Congenital hypoganadotrophic hypogonadism (Kallmann syndrome)
Acquired hypoganadotrophic hypogonadism (low BMI, exercise, stress)
Hyperprolactinaemia

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20
Q

What are Gnrh, LH, FSH, testosterone levels in infertile males when the problem is in the hypothalamus?

A

All low

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21
Q

What male infertility problems arise due to anterior pituitary problems?

A

Hypopituitarism, tumour, Infiltration, Apoplexy, Surgery, Radiation

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22
Q

What are LH, FSH, testosterone levels in infertile males when the problem is in the hypothalamus?

A

All low

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23
Q

What male infertility problems arise due to gonad problems?

A

Klinefelters

Acquired primary hypogonadism (cryptorchidism, trauma, chemo, radiation)

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24
Q

What are LH, FSH, testosterone levels in infertile males when the problem is in the testes?

A

LH/FSH high

Testosterone low

25
Q

What is Kallmann’s syndrome?

A

Failure of migration of GnRH neurons with olfactory fibres

26
Q

How will Kallmann’s syndrome present?

A 
Cryptorchidism
Failure of puberty
-Lack of testicle development
-Micropenis
-Primary amenorrhoea
Infertility
Anosmia
27
Q

What hormone blocks kisspeptin neurones?

A

Prolactin

28
Q

How does hypogonadism present?

A

Oligo or amenorrhoea /Low libido/ Infertility/Osteoporosis

29
Q

What are the causes of hyperprolactinaemia?

A 
Prolactinoma
Pituitary stalk compression
Pregnancy and breastfeeding
Medications (dopamine antagonists)
PCOS
Hypothyroidism
30
Q

What happens to sex chromosomes in Klinefelter’s?

A

Extra X chromosome (XXY)

31
Q

How does Klinefelter’s present?

A 
Tall stature
Low facial and chest hair
Breast development
Small penis and testes
Wide hips
Low bone density
Female like pubes
Narrow shoulders
32
Q

What should you include when taking history for an infertile man?

A

Duration, previous children, pubertal milestones, associated symptoms (eg. T deficiency, PRL symptoms, CHH features), medical & surgical history, family history, social history, medications/drugs

33
Q

How should you examine an infertile man?

A

BMI, sexual characteristics, testicular volume, epididymal hardness, presence of vas deferens, other endocrine signs, syndromic features, anosmia

34
Q

What are the main investigations for infertile males?

A

Semen analysis
Blood tests- LH, FSH, fasting testosterone, SHBG, albumin, iron, karyotyping
Microbiology- urine test, chlamydia swab
Imaging

35
Q

What should male sperm vol be?

A

1.5 ml

36
Q

What should sperm count be?

A

15 mill/ml

37
Q

What should sperm motility be?

A

40%

38
Q

What lifestyle changes are advised for infertile males?

A

Optimise BMI
Smoking cessation
Alcohol reduction/cessation

39
Q

What treatment is available for infertile males?

A

Dopamine agonist for hyperprolactinemia

Gonadotrophin treatment for fertility (will also increase testosterone)

Testosterone
(for symptoms if no fertility required – as this requires gonadotrophins)

Surgery

40
Q

Whats primary amenorrhea?

A

No period ever and >16 yrs old

41
Q

Whats secondary amenorrhea?

A

Irregular periods, start but stop for 3-6 months

42
Q

What would LH/FSH and oestradiol levels be in premature ovarian insufficiency?

A

LH-high
FSH-high
Oestradiol-low

43
Q

What are symptoms of premature ovarian insufficiency (POI)?

A

Same as menopause

44
Q

What are causes of POi

A

Autoimmune, genetic (fragile X or turners), cancer therapy

45
Q

What would LH/FSH and oestradiol levels be in anorexia nervosa induced amenorrhea?

A

LH-low
FSH-low
Oestradiol-low

46
Q

What are Gnrh, LH, FSH, oestradiol levels in infertile females when the problem arises due to the hypothalamus?

A

All low

47
Q

What are LH, FSH, oestradiol levels in infertile females when the problem arises due to the anterior pituitary?

A

All low

48
Q

What are LH, FSH, oestradiol levels in infertile females when the problem arises due to the ovary?

A

LH/FSH high

Oestradiol low

49
Q

What is PCOS?

A

Most common cause of female infertility

50
Q

How is PCOS diagnosed?

A

2/3 out of:
Oligo/anovulation- assessed by menstrual frequency

Hyperandrogenism- acne, hirtuism, alopecia, high testosterone

Polycystic ovaries

51
Q

How is PCOS amenorrhea treated?

A

Oral contraceptive pill

Metformin

52
Q

How is PCOS increased insulin resistance treated?

A

Metformin

53
Q

How is PCOS hirtuism treated/

A

Creams/wax/laser, anti androgens

54
Q

How does turners present and in what gender?

A 
Females:
Short
Low hairline
Wide spaced nipples
Poor breast development
Amenorrhea
55
Q

How should you take a history for an infertile female?

A

Duration, previous children, pubertal milestones, breastfeeding,
Menstrual History: oligomenorrhoea or 1/20 amenorrhoea, associated symptoms, medical & surgical history, family history, social history, medications/drugs

56
Q

How should you examine an infertile female?

A

BMI, sexual characteristics, hyperandrogenism signs, pelvic examination, other endocrine signs, syndromic features, anosmia

57
Q

What are the main investigations for infertile females?

A

Blood test
Pregnancy test
Microbiology
Imaging

58
Q

Describe the difference between Klinefelters, Kallmanns, Turner’s and fragile x syndrome

A

Klinefelter’s- congenital primary testicular failure, extra x chromosome
Kallmann’s- congenital hypogonadotrophic hypogonadism (due to problems in the pituitary)
Turner’s- congenital female condition where they are partially missing an x chromosome
Fragile X- congenital condition affecting x chromosome leading to developmental problems, intellectual disability etc

BRS Y2 (85 decks)

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