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X Women's Health > Infertility and Abortion > Flashcards

Infertility and Abortion Flashcards

1
Q

Fertility

A

Capacity to conceive and produce offspring

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2
Q

Fecundability

A

Probability or achieving a pregnancy in one menstrual cycle

More accurate descriptor b/c recognizes varying degrees of infertility

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3
Q

Infertility

A

Diminished capacity to conceive despite frequent coitus

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4
Q

Subfertility

A

More appropriate description of most infertile couples

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5
Q

Sterility

A

Inability to conceive offspring, usually used after sterilization procedure or specific illness, exposure or genetic condition (mumps, chemo, klinefelter)

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6
Q

Why does fecundability decrease?

A

As woman ages due to declining quantity and quality of oocytes (first 3 cycles of unprotected intercourse=.25 and decreased over next 9 months of cycles)

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7
Q

How to define infertility

A

Inability to conceive after 12 mos of unprotected intercourse for women 35 or younger
Inability to conceive after 6 mos of unprotected intercourse for women 35+

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8
Q

Primary and secondary infertility

A

Primary: individuals who have never conceived (higher 40-44 YO)
Secondary: infertility after prior fertility

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9
Q

Causes of infertility

A

Male factor
Female factor (37%)
Combned
Unknown

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10
Q

Categories of male factor infertility

A

Endocrine and systemic disorders
Primary testicular defects in spermatogenesis
Sperm transport disorders
Idiopathic male infertility

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11
Q

Clinical semen findings in male factor infertility

A

Low sperm conc
Absent sperm
Motility issues
Morphology issues

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12
Q

How to obtain semen analysis

A

Masturbation sample at office or lab
2-7 days of sexual abstinence
2 samples taken 1-2 wks apart

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13
Q

Serum analysis WHO criteria

A

Vol: 1.5 ml
Sperm conc: 15 mil spermatozoa/mL
Total sperm number: 39 mil spermatazoa per ejaculate
Morphology: 4% normal forms, strict Tygerbergmethod
Vitality: 58% live
Progressive motility: 32%
Total (progressive and nonprogressive motility)- 40%

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14
Q

Most common congenital abnormality causing primary hypogonadism

A

Klinefelters (47 XXY)

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15
Q

Main contributing factors of female factor infertility

A

Ova
Patent oviduct
Anatomic abnormalities of uterua

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16
Q

What to consider with ova

A

Quantity and quality: age and surgeries/injury to ovary

Ovulation: discharge of ova or ovules from ovary

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17
Q

Complications of ovulation

A 
Polycystic ovarian syndrome
Thyroid dysfunction (hyper and hypo)
Hyperprolactinemia
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18
Q

Presentation of polycystic ovarian syndrome

A

Cutaneous signs of hyperandrogenism
Oligomenorrhea or amenorrhea
Obesity and insulin resistance

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19
Q

Causes of oligomenorrhea and amenorrhea in PCOS

A

Lack of progesterone (no corpus luteum) causing unopposed estrogen exposure–hyperplastic growth
Irregular sloughing of endometrium–oligomenorrhea

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20
Q

High prolactin states

A 
Breastfeeding
Breast stimulation/intercourse
Extreme exercise
Meds (risperidone)
If persistently elevated look for pituitary adenoma on MRI
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21
Q

Tx of PCOS

A

Diet and exercise
Provera cycling
Metformin
Clomiphene

22
Q

Tx of thyroid def

A

PTU or levothyroxine

23
Q

Tx of prolactinemia

A

Bromocriptine (Safe in pregnancy but stop when get + pregnancy test)

24
Q

What is clomiphine?

A

SERM

Serious short term complication of ovarian hyperstimulation (lead to thromboembolic events)

25
Q

Tubal factors leading to infertility

A

Occluded oviducts (proximal or distal, from untreated STDs or PID, mucous or anatomic abnormalities)
Injury/surgery to oviduct
r/o with hysterosalpingogram

26
Q

Limitations of HSG

A

Not covered by insurances
Maybe painful
Evaluates for tubal patency not function

27
Q

Txs for tubal factors

A

Surgical tubal repair

IVF

28
Q

Surgical tubal repair

A

Rarely performed
High failure rates
Increased risk of ectopic pregnancy

29
Q

2 most important questions for fertility HPI

A

Regular menstrual cycles?? (21-35 days and varying 2-7 days in length)
How often are they having intercourse??- recommend every other day around ovulation

30
Q

Other pertinent history questions for fertility

A

Dysmenorrhea?
History of irregular menses?
Signs of regular ovulation?

31
Q

Signs of regular ovulation

A

Evaluate cervical mucous (spinnbarkeit or egg white)
Breast tenderness resolves with menses onset
Mittelschmerz (pain with ovulation)
Swelling or bloating that subsides with menses
Day 21 progesterone lab draw

32
Q

Important HPI for female

A

Age, medical history, meds, social history review, surgical history

33
Q

Important HPI for male

A

Medical history (mumps)
Meds
Social history (anabolic steroids, EtOH, chemo, psychotropic meds, chemicals)
Surgical history (vasectomy, hernia repair, orchiectomy)
Developmental history

34
Q

Combo HPI

A

Primary vs secondary infertility (successful, abortions and miscarriages too)
How long trying
Contraceptives previously?

35
Q

When to start fertility tx if know there is specific cause for infertility?

A

No need to wait 6-12 mos so refer early

36
Q

Reasons for elective abortion

A

Unplanned pregnancy
Fetal anomalies
Maternal health

37
Q

Meds for elective abortion

A

Misoprostol or mifepristone
May have risk of retained products of infection (prophylactic abx)
FDA approved to 70 days gestation

38
Q

Surgical way for elective abortion

A

Depending on gestational age:
Suction D&C
Dilation and evacuation
Stimulation of labor

39
Q

Definition of spontaneous abortion

A

Miscarriage
Pregnancy loss which occurs prior to 20 wks gestation
Most common complication of pregnancy

40
Q

Work up for spontaneous abortion

A

CBC
Rh type
HCG quantitative
Pelvic and transvaginal u/s

41
Q

Important things to remember for spontaneous abortion

A

Most common cause is abnormal karyotype (>50%)
Usually in first trimester (<8 wks)
Genetic studies rarely performed for isolated SAB
Rh neg women need rhogram injection

42
Q

Complete spontaneous abortion

A

Complete passage of products of conception

43
Q

Incomplete spontaneous abortion

A

Retention of part/all products of conception

44
Q

Threatened spontaneous abortion

A

Closed cervical os- bleeding with + urine pregnancy test

45
Q

Inevitable spontaneous abortion

A

Open cervical os (presents with bleeding)

46
Q

Missed abortion

A

Absent heartbeat without bleeding, cervix is closed

47
Q

Septic spontaneous abortion

A

Any above abortion with infected POC (products of conception) or endometrial lining

48
Q

Recurrent abortion

A

Three or more consecutive losses prior to 20 wks (SABs)
“Habitual aborter”
Risk increases with each subsequent SAB
Refer to reproductive endocrinology

49
Q

Causes of recurrent abortion

A 
Abnormal karyotype
Uterine malformations
Antiphospholipid antibody (Antiphospholipid syndrome)-lupus common co-presentation
Chronic uncontrolled med conditions
Insufficient progesterone levels
50
Q

Work up for recurrent abortion

A 
History (age, chronic disease)
Karyotype of both parents
Karyotype of aborted embryo
Luteal phase progesterone
Antiphospholipid Ab
Lupus work up
Uterine cavity eval
51
Q

First thing to always check with fertility and pregnancy!!!

A

BMI

X Women's Health (4 decks)

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