Infertility, Abortion, Multiple Gestation Flashcards
Infertility
Diminished capacity to conceive despite freq coitus
Better term is sub fertility
Fertility/Fecundity
Capacity to conceive and produce offspring
Sterility
Inability to conceive offspring usu after sterilization procedure or illness
How long does it take normal healthy couples to conceive w/in the 1st 6mos of unprotected intercourse
12mos
How does age affect the capacity to conceive in women
Decreases due to declining number and qty of oocytes
Female etiologies for subfertility
Endometriosis
Tubal factors/ovulation
other
Male etiologies for subfertility
Semen related (quantity and quality)
What organs does the basic work up of infertility work up
Ova
Spermatozoa
Patent oviduct
When are women most fertile
20s
Fecundability
Probability that conception will occur during a specific time period
Spinnbarkeit
Stringiness of cervical mucous before ovulation (Egg white cervical mucous)
Signs and symptoms of ovulation
Eval of mucous
Breast tenderness w/ onset of menses
perception of swelling/bloating that resolves w/ menses
Mittelschmerz
Mittelschmerz*
Pain associated w/ periods
What is the role of Spinnbarkeit
Believed to assist in sperm transport
What hormone is responsible for most pre-menstrual sxs
Progesterone
What aspects of the female PE are essential for the work up of fertility
BMI
Vitals (HTN, tachycardia)
Integuments (Acanthosis nigracans, Acne, Hirsutism)
What BMI make fertility difficult
BMI > 27 or
What are the complications for ovulation (causes of anovulatory cycles)
PCOS
Thyroid dysfxn
Hyperprolactinemia
What does anovulatory cycles mean
Have irregular sloughing of endometrium
U/S finding for PCOS
String of pearls sign
DOC in PCOS for women who want to become pregnant
Clomid
How does Clomid use affect twin pregnancy rate
It increases it
Ovarian hyperstimulation syndrome
women on fertility tx produce multiple eggs
Test of choice to rule out Tubal blockage
Hysterosalpingogram
What causes tubal blockage
untreated STI/PID
Surgical procedures
hydrosalpinx/clubbed tubes
mucus plug
most common abn causing 1˚ hyperandrogenism
Klinefelter’s syndrome
Most common complication of pregnancy
Spontaneous abortion
Spontaneous abortion
Pregnancy loss prior to 20wks
Complete abortion
Complete passage of products of conception
Incomplete abortion
Retention of pdts. of conception
Threatened abortion
Bleeding w/ a closed cervical os
Inevitable abortion
Open os usu. w/ bleeding
Missed abortion
Absent heartbeat w/out bleeding w/ os closed
Septic abortion
Any abortion w/ infected POC/endometrial lining
Recurrent abortion
3 or more consecutive pregnancy losses prior to 20 wks
What is the most common cause of spontaneous miscarriage
Abnormal karyotype
When do abn. karyotype miscarriages usu occur
Are most twin gestations mono or dizygotic
Dizygotic
How is inheritance for twins passed along
Mothers side
Factors that increase the potential for multizygocity
increasing age
Use of fertility tx
How is twin gestation determined
U/S
U/S finding for dizygotic twin
Twin peaks/Lambda sign
U/S finding for monozygotic twins
T sign
planned delivery for monozygotic twins
34-37 wks
Planned delivery for dizygotic twins
38-40 wks
Risk factors for multiple gestation
Cord entanglement Cord prolapse Twin-twin transfusion C section Pre-term labor Hypoxemia Growth restriction Risk of conjoined twins
Complication of using Clomid (SERM)
Ovarian Hyperstimulation syndome
male factors contributing to infert
Hypothalamic pituitary dysfunction
1˚ hypogonadism
Post testicular defects
Seminiferous tubule dysfunction
Semen findings for male infertility
Low sperm count
absent sperm
Aberrent motility
aberrent morphology
How to obtain a semen sample
masturbation in office, 2 samples one week apart, 2-7days sexual abstinence
Meds used for abortion
Misoprostol
Mifepristone
