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Obs and Gynae > Infertility > Flashcards

Infertility Flashcards

1
Q

Where is the hypothalamus found?

A

Lateral wall of the 3rd ventricle

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2
Q

Where is GnRH secreted from in the brain and what is the pattern of release?

A

Hypothalamus, decapeptide, pulsatile fashion every 90 minutes

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3
Q

What 6 glycoproteins are released from the anterior pituitary?

A

FSH, LH, Prolactin, TSH, GH, ACTH

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4
Q

What 2 peptide hormones are released from the posterior pituitary?

A

ADH and oxytocin

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5
Q

Purpose of FSH and LH?

A

FSH helps follicle development and LH helps ovulation and convert graffian follicle into corpus luteum

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6
Q

Where does the oestrogen get released from in a developing follicle?

A

granulosa cells surrounding oocyte

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7
Q

How does oestrogen act to reduce FSH production?

A

Negative feedback which produces inhibin to oppose FSh release

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8
Q

What happens when oestrogen converts from a negative feedback loop to a positive one?

A

Day 12 surge in LH and FSH causing ovulation on day 14

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9
Q

Purpose of LH in secretory phase?

A

Corpus luteum development caused by lutenisation

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10
Q

What is the actual cause of menstruation?

A

Fall in progesterone

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11
Q

How is the corpus luteum maintained in pregnancy?

A

HCG from trophoblastic and placenta cells

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12
Q

During pregnancy how long is it till the corpus luteum is no longer needed?

A

7 weeks

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13
Q

Common causes of infertility?

A

Azoospermia, tubal, endometriosis, ovulatory

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14
Q

‘COST’ investigation areas?

A

Coitus, ovulation, sperm, tubal

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15
Q

What questions should you ask about the sex in infertility?

A

Frequency, timing, ED

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16
Q

What questions should you ask a women to see if she is ovulatin?

A

Mucus changes, mid cycle pain, regular cycles, PMS

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17
Q

PCOS symptoms?

A

irregular menses, hirtuism, acne, weight gain, polycystic ovaries, LH:FSH ratio reversed

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18
Q

What drug can be given to induce ovulation in PCOS?

A

CLOMID

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19
Q

Symptoms of hyperprolactinaemia?

A

Galactorrhoea, amenorrhea, oestrogen deficiency

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20
Q

In hyperprolactinaemia what will the FSH, LH, oestrogen levels be?

A

All low

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21
Q

What dopamine agonist can be given to treat hyperprolactinaemia?

A

Bromocriptine

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22
Q

What will the FSH and oestrogen levels be like in premature ovarian failure?

A

High FSH and low oestrogen

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23
Q

When is FSH measured in the cycle to check for anovulation?

A

DAy 3 of cycle

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24
Q

WHat day of the cycle is progesterone tested?

A

Day 21 - mid luteal

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25
Q

What level of progesterone symbolises that the patient is ovulating?

A

Above 30

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26
Q

How can USS help determine ovulation?

A

Can track follicle maturation, pre ovulatory are 18-20mm

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27
Q

History questions to determine tubal patency?

A

PID, STDs, endometriosis, tubal surgery, cyclical pain, dyspareunia, ectopics, post abortion sepsis

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28
Q

What investigations can you do into tubal patency?

A

Hysteroscopy, methylene blue dye test, hysterosalpingogram

29
Q

Usual presentation of endometriosis?

A

Dyspareunia, dysmenorrhoea, pelvic pain, gunpowder spots, endometrioma

30
Q

Define infertility

A

Inability to conceive after 1 year unprotected coitus

31
Q

What is varicocele?

A

Venous blood at higher temp trapped around testes

32
Q

What immunological abnormalities may be present in an infertile male?

A

Anti-sperm antibodies

33
Q

How do calcium channel blockers lead to infertility in males?

A

Decrease sperm ability to penetrate egg

34
Q

Chronic effect of STDs in males?

A

Epididymitis

35
Q

What can cause testicular dysgenesis syndrome?

A

consuming things like xenoestrogens

36
Q

What happens if testicular dysgenesis syndrome effects sertoli cells vs leydig cells?

A

sertoli - impaired sperm quality, leydig - congenital abnormalities caused by altered testosterone production

37
Q

What is usual concentration of semen?

A

20 million per ML

38
Q

What does ICSI stand for and when is it used

A

intracytoplasmic sperm injection for immobile sperm

39
Q

How can you tell if a man has azoospermia or obstructive azoospermia?

A

High FSH and LH in non-obstructive

40
Q

Investigations into male infertility

A

Chromosome analysis, endocrine (FSH,LH,Inhibin,testosterone), CF, anti sperm antibodies, hormone profile

41
Q

What does PESA stand for?

A

percutaneous epididymal sperm aspiration

42
Q

What is a TESE?

A

open testicular biopsy

43
Q

What is TESA? RIsks?

A

fine needle testicular sperm aspiration, architectural distortion

44
Q

What is TESET? what gauge needle?

A

testicular sperm extraction with Trucut needle, 14 gauge

45
Q

What is found within the eggs granulosa cells?

A

Zone pellucida

46
Q

What happens when sperm reaches zona pellucida?

A

hyperactivated, release enzymes from acrosome

47
Q

What 2 things can be given in ovulation dysfunction?

A

Clomid, FSH injections

48
Q

Difference between ICSI and TICSI?

A

Almost completely immobile sperm are taken directed from testes to be injected

49
Q

What does FET stand for?

A

Frozen embryo transfer

50
Q

What does GIFT stand for?

A

gamete intrafallopian transfer

51
Q

What does ZIFT stand for?

A

zygote intrafallopian transfer

52
Q

How do you initially take control of the menstrual cycle in IVF treatment?

A

Nasal spray to suppress GnRH release

53
Q

Once the menstrual cycle is controlled, what is given to the woman wanting to undergo IVF? what monitoring is performed?

A

FSH injections with USS monitoring of ovaries

54
Q

What is given to the woman 36 hours before egg collection in IVF?

A

HCG injection

55
Q

In IVF how long is the embryo grown for before reimplantation?

A

2-5 days (6-8 cells)

56
Q

Potential complications of IVF treatment?

A

OHSS, Multiple pregnancies, visceral damage or PID, fetal abnormality

57
Q

What can OHSS result in for the woman?

A

Increases permeability leading to pleural effusions, ascites, concentrated blood, blood clots!!

58
Q

How is the issue of multiple pregnancies combatted in a mother undergoing IVF?

A

if they are under 40 only implant 1 embryo of good quality

59
Q

Oligozoospermia?

A

Too few sperm

60
Q

Asthenozoospermia?

A

Not moving well

61
Q

Teratozoospermia?

A

Grossly abnormal sperm

62
Q

Azoospermia?

A

No sperm in ejaculate

63
Q

Difference between oligozoospermia and azoospermia?

A

Oligo is too few sperm and azoo is no sperm in ejaculate

64
Q

Why do you take the FSH level on day 2/3 of a womans normal cycle before initiating IVF?

A

To see if they will respond to the FSH injections

65
Q

What FSH levels suggests the woman will be unresponsive to IVF?

A

over 14 IU/l

66
Q

What FSH level suggests that a woman will be responsive to IVF treatment?

A

Below 8 IU/l

67
Q

What is the purpose of giving a women serum AMH before IVF?

A

response shows how likely the woman is of having oHSS

68
Q

What is the age limit for receiving donor eggs?

A

50

Obs and Gynae (27 decks)

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