Infertility Flashcards
Where is the hypothalamus found?
Lateral wall of the 3rd ventricle
Where is GnRH secreted from in the brain and what is the pattern of release?
Hypothalamus, decapeptide, pulsatile fashion every 90 minutes
What 6 glycoproteins are released from the anterior pituitary?
FSH, LH, Prolactin, TSH, GH, ACTH
What 2 peptide hormones are released from the posterior pituitary?
ADH and oxytocin
Purpose of FSH and LH?
FSH helps follicle development and LH helps ovulation and convert graffian follicle into corpus luteum
Where does the oestrogen get released from in a developing follicle?
granulosa cells surrounding oocyte
How does oestrogen act to reduce FSH production?
Negative feedback which produces inhibin to oppose FSh release
What happens when oestrogen converts from a negative feedback loop to a positive one?
Day 12 surge in LH and FSH causing ovulation on day 14
Purpose of LH in secretory phase?
Corpus luteum development caused by lutenisation
What is the actual cause of menstruation?
Fall in progesterone
How is the corpus luteum maintained in pregnancy?
HCG from trophoblastic and placenta cells
During pregnancy how long is it till the corpus luteum is no longer needed?
7 weeks
Common causes of infertility?
Azoospermia, tubal, endometriosis, ovulatory
‘COST’ investigation areas?
Coitus, ovulation, sperm, tubal
What questions should you ask about the sex in infertility?
Frequency, timing, ED
What questions should you ask a women to see if she is ovulatin?
Mucus changes, mid cycle pain, regular cycles, PMS
PCOS symptoms?
irregular menses, hirtuism, acne, weight gain, polycystic ovaries, LH:FSH ratio reversed
What drug can be given to induce ovulation in PCOS?
CLOMID
Symptoms of hyperprolactinaemia?
Galactorrhoea, amenorrhea, oestrogen deficiency
In hyperprolactinaemia what will the FSH, LH, oestrogen levels be?
All low
What dopamine agonist can be given to treat hyperprolactinaemia?
Bromocriptine
What will the FSH and oestrogen levels be like in premature ovarian failure?
High FSH and low oestrogen
When is FSH measured in the cycle to check for anovulation?
DAy 3 of cycle
WHat day of the cycle is progesterone tested?
Day 21 - mid luteal
What level of progesterone symbolises that the patient is ovulating?
Above 30
How can USS help determine ovulation?
Can track follicle maturation, pre ovulatory are 18-20mm
History questions to determine tubal patency?
PID, STDs, endometriosis, tubal surgery, cyclical pain, dyspareunia, ectopics, post abortion sepsis
What investigations can you do into tubal patency?
Hysteroscopy, methylene blue dye test, hysterosalpingogram
Usual presentation of endometriosis?
Dyspareunia, dysmenorrhoea, pelvic pain, gunpowder spots, endometrioma
Define infertility
Inability to conceive after 1 year unprotected coitus
What is varicocele?
Venous blood at higher temp trapped around testes
What immunological abnormalities may be present in an infertile male?
Anti-sperm antibodies
How do calcium channel blockers lead to infertility in males?
Decrease sperm ability to penetrate egg
Chronic effect of STDs in males?
Epididymitis
What can cause testicular dysgenesis syndrome?
consuming things like xenoestrogens
What happens if testicular dysgenesis syndrome effects sertoli cells vs leydig cells?
sertoli - impaired sperm quality, leydig - congenital abnormalities caused by altered testosterone production
What is usual concentration of semen?
20 million per ML
What does ICSI stand for and when is it used
intracytoplasmic sperm injection for immobile sperm
How can you tell if a man has azoospermia or obstructive azoospermia?
High FSH and LH in non-obstructive
Investigations into male infertility
Chromosome analysis, endocrine (FSH,LH,Inhibin,testosterone), CF, anti sperm antibodies, hormone profile
What does PESA stand for?
percutaneous epididymal sperm aspiration
What is a TESE?
open testicular biopsy
What is TESA? RIsks?
fine needle testicular sperm aspiration, architectural distortion
What is TESET? what gauge needle?
testicular sperm extraction with Trucut needle, 14 gauge
What is found within the eggs granulosa cells?
Zone pellucida
What happens when sperm reaches zona pellucida?
hyperactivated, release enzymes from acrosome
What 2 things can be given in ovulation dysfunction?
Clomid, FSH injections
Difference between ICSI and TICSI?
Almost completely immobile sperm are taken directed from testes to be injected
What does FET stand for?
Frozen embryo transfer
What does GIFT stand for?
gamete intrafallopian transfer
What does ZIFT stand for?
zygote intrafallopian transfer
How do you initially take control of the menstrual cycle in IVF treatment?
Nasal spray to suppress GnRH release
Once the menstrual cycle is controlled, what is given to the woman wanting to undergo IVF? what monitoring is performed?
FSH injections with USS monitoring of ovaries
What is given to the woman 36 hours before egg collection in IVF?
HCG injection
In IVF how long is the embryo grown for before reimplantation?
2-5 days (6-8 cells)
Potential complications of IVF treatment?
OHSS, Multiple pregnancies, visceral damage or PID, fetal abnormality
What can OHSS result in for the woman?
Increases permeability leading to pleural effusions, ascites, concentrated blood, blood clots!!
How is the issue of multiple pregnancies combatted in a mother undergoing IVF?
if they are under 40 only implant 1 embryo of good quality
Oligozoospermia?
Too few sperm
Asthenozoospermia?
Not moving well
Teratozoospermia?
Grossly abnormal sperm
Azoospermia?
No sperm in ejaculate
Difference between oligozoospermia and azoospermia?
Oligo is too few sperm and azoo is no sperm in ejaculate
Why do you take the FSH level on day 2/3 of a womans normal cycle before initiating IVF?
To see if they will respond to the FSH injections
What FSH levels suggests the woman will be unresponsive to IVF?
over 14 IU/l
What FSH level suggests that a woman will be responsive to IVF treatment?
Below 8 IU/l
What is the purpose of giving a women serum AMH before IVF?
response shows how likely the woman is of having oHSS
What is the age limit for receiving donor eggs?
50
