infertility and abortion

Question 1

SAB: no heartbeat

no bleeding

cervix closed

Answer 1

missed abortion

Question 2

diagnostic workup for spontaneous abortion (SOB)

Answer 2

CBC

Rh type ⇒ give Rhogam if mom is Rh negative!!!

hCG

pelvic and transvag US

Question 3

what are some causes of recurrent abortion

Answer 3

abnormal karyotype

uterine malformations

antiphospholipid syndrome

chronic medical conditions

insufficient progesterone levels

Question 4

infertility

vs

subfertility

vs

sterility

Answer 4

• infertility
  
  • diminished capacity to conceive despite frequent sex
• subfertility
  
  • more appropriate description of most infertile couples
• sterility
  
  • complete inability to conceive offspring
  • usually ccurs after procedure/ illness/ exposure/ genetic condition

Question 5

what medications are used for elective abortion and how far along can the patient be to take them

Answer 5

misoprostol

mifepristone

up to 70 days GA

Question 6

SAB: closed cervical os

bleeding

positive pregnancy test

Answer 6

threatened

Question 7

most common complication of pregnancy

Answer 7

pregnancy loss which occurs prior to 20 weeks gestation =

spontaneous abortion

aka miscarriage

Question 8

when do you evaluate for infertility

Answer 8

after 12 months of unprotected sex in women under 35

after 6 months of unprotected sex in women over 35

Question 9

what are you looking for in a sperm sample

Answer 9

low sperm concentration

absent sperm

motility issues

morphology issues

are they alive

Question 10

what surgical procedures are used for elective abortion

Answer 10

suction D and C

dilation and evacuation

stimulation of labor

Question 11

fecundability ____ over time

Answer 11

decreases over time

0.25 for the first 3 cycles

down to 0.15 for the next 9 cycles

Question 12

main cause of infertility

Answer 12

female factor (37%)

then male factor (8%)

Question 13

tx of anovulation for PCOS

Answer 13

diet and exercise education

provera cycling

metformin

clomiphene 50 mg PO x 5 days

Question 14

how do you determine if the cause of infertility is due to a tubal factor (oviduct patency)

Answer 14

hysterosalpingogram (HSG)

not covered by most insurance

painful

does not eval tubal function, just patency

Question 15

what drug is used for ovulation induction

Answer 15

clomiphene

Selective Estrogen Receptor Modulator

works 60-85% of the time

rate of twin pregnancy is 7-9%

can cause life threatening hyperstimulation

Question 16

what are the 4 main categories of female infertility

Answer 16

• ova
  
  • older age/ surgeries
• ovulation
  
  • PCOS, thyroid dysfunction, hyperprolactinemia (from breast feeding/ breast stimulation/ exercise/ meds like risperidone/ pituitary adenoma)
• oviduct patency (distal or proximal)
  
  • due to untreated STI/ hydrosalpinx/ mucous/ anatomic anomalies/ salpingectomy/ prior ectopic pregnancy
• uterine anatomic abnormalities

Question 17

what are the 4 main categories of male infertility

Answer 17

• enodcrine and systemic disorders
  
  • GnRH deficiency, iron overload, multi-organ disorder, pituitary/ hypothalamic disorder/ tumor, hormonal, drugs (androgens, opiods, psychotrophic, GnRH ag and antag), obesity, nutritional deficiencies
• primary testicular defects in spermatogenesis
  
  • klinefelter, cryptorchidism, androgen insensitivity syndromes, variocele, drugs (marijuana, ETOH, antiandrogens, ketoconazole, spironolactone)
• sperm transport disorders
  
  • epidydimal/ vas derferens/ seminal vesicles/ prostate/ ejaculatory ducts disorders
• idiopathic

Question 18

SAB: open cervical os

bleeding

+ pregnancy test

Answer 18

inevitable

Question 19

tx of anovulation for hyperprolactinemia

Answer 19

bromocriptine

Question 20

fecundability

vs

fertility

Answer 20

fecundability- the probability of achieving a pregnancy in one menstrual cycle

vs

fertility- ability to conceive and produce offspring

fecundability is a more accurate descriptor

Question 21

tx for female infertility due to a tubal factor

Answer 21

usually IVF

surgical tubal repair has high failure rates and increased risk of ectopic pregnancy

Question 22

SAB: complete pasasge of products of conception

Answer 22

complete

Question 23

how to obtain a semen analysis

Answer 23

patient is abstinent for 2 to 7 days

2 masterbation samples taken, 1 to 2 weeks apart

Question 24

SAB: retention of part or all products of conception

Answer 24

incomplete

Question 25

___ or more consecutive losses prior to 20 weeks are called ___

Answer 25

3 or more consecutive losses prior to 20 weeks are called recurrent abortion

Question 26

if someone has thyroid problems and is trying to become pregnant, what meds should they take

Answer 26

hyperthyroid- PTU

hypothyroid- levothyroxine