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Y3 Reproduction > Infertility and Assisted Conception > Flashcards

Infertility and Assisted Conception Flashcards

1
Q

what is the definition of infertility?

A

inability to conceive after twelve months regular intercourse without contraception

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2
Q

what is primary infertility?

A

when someone who has never had a child before has trouble conceiving

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3
Q

what is secondary infertility?

A

when someone who has had one or more pregnancies struggles to conceive

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4
Q

how long are regular menstrual cycles?

A

28-35 days

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5
Q

what is the first day of the menstrual cycle?

A

the first day of menstruation

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6
Q

what are the two phases of the menstrual cycle?

A

follicular phase

luteal phase

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7
Q

what defines the follicular and luteal phase?

A

ovulation

follicular before, luteal after

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8
Q

how long is the luteal phase?

A

ALWAYS 14 days long

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9
Q

how long is the follicular phase?

A

variable

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10
Q

how long does bleeding usually last during the menstrual cycle?

A

3-8 days

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11
Q

how is the length of the menstrual cycle annotated?

A

7 days bleeding out of a 28 day cycle = 7/28 for example

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12
Q

what is oligomenorrhoea?

A

cycles >35 days long

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13
Q

what is amenorrhoea?

A

absence of menstruation

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14
Q

what are the two types of amenorrhoea?

A

primary

secondary

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15
Q

what is primary amenorrhoea?

A

never had a period

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16
Q

what is secondary amenorrhoea?

A

had a period but now they have stopped

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17
Q

what triggers ovulation?

A

LH surge

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18
Q

what hormone peaks following ovulation?

A

progesterone

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19
Q

what can be used to detect ovulation and how does this work?

A

an ovulation predictor kit

detects the LH surge

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20
Q

when does the LH surge occur?

A

24-36 hours prior to ovulation

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21
Q

what are regular menstrual cycles suggestive of?

A

ovulation

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22
Q

how can ovulation be confirmed?

A

mudluteal serum progesterone >30nmol/L

should be taken on day 21/28 - adjust for cycle length

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23
Q

what do irregular cycles suggest and what should be done?

A

likely anovulatory

need further hormone evaluation

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24
Q

what are the five initial investigations done for infertility in a female?

A 
day 21 progesterone 
TSH 
rubella immunity 
chlamydia screen 
up to date cervical smear
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25
Q

what blood tests are done if a female is amenorrhoeic or has cycles lasting longer than 42 days?

A

follicular phase bloods - LH, FSH, E2

testosterone

SHBG

prolactin

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26
Q

what initial investigation is done for infertility in males?

A

diagnostic semen analysis

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27
Q

what is azoospermia?

A

no sperm in ejaculate

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28
Q

what is asthenozoospermia?

A

% of progressive motile sperm is below the reference limit

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29
Q

what is the lower reference limit for sperm concentration?

A

16 x 10^6 per ml

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30
Q

what is the lower reference limit for sperm with progressive motility?

A

30%

31
Q

what is the lower reference limit for sperm with normal morphology?

A

4%

32
Q

what is oligozoospermia?

A

total number/concentration of sperm is below the reference limit

33
Q

what is teratozoospermia?

A

the percentage of morphologically normal sperm is below the reference limit

34
Q

what is oligoasthenozoospermia?

A

low count + low motility

35
Q

what is oligoteratozoospermia?

A

low count + poor morphology

36
Q

what is asthenoteratozoospermia?

A

low motility + poor morphology

37
Q

what is oligoasthenoteratozoospermia?

A

low motility + low count + poor morphology

38
Q

what two things need to be established as part of an infertility consultation?

A

length of the relationship

length of time trying to get pregnant

39
Q

what three things are done for the female during an infertility consultation?

A

history
examination/ultrasound
investigations

40
Q

what four things are done for the male during an infertility consultation?

A

history
diagnostic semen analysis
examination
investigations

41
Q

what can usually be seen on a transvaginal ultrasound?

A

uterus and ovaries

uterine tubes usually not easily identified

42
Q

what is hydrosalpinx?

A

fluid in the Fallopian tubes

43
Q

what test is done to asses tubal patency?

A

hysterosalpingogram (HSG)

44
Q

what is involved in an HSG scan?

A

an x-ray scan

catheter is inserted into the cervix and a dye is injected which should pass through the tubes if they are patent

45
Q

what other investigation can be done to assess tubal potency if HSG is abnormal/contraindicated?

A

diagnostic laparoscopy and hydrotubation (HTB)

46
Q

when is diagnostic laparoscopy and hydrotubation (HTB) chosen over HSG?

A

possible tubal/pelvic disease
known previous pathology
previously abnormal HSG

47
Q

what is hysteroscopy used to look at?

A

the uterus

48
Q

when is hysteroscopy performed?

A

when there is suspected or known endometrial pathology

49
Q

what lifestyle advice should you give to optimise chances of conception?

A 
stop smoking 
BMI normal range 
reduce alcohol and caffeine 
stop recreational drugs 
take folic acid
50
Q

what lifestyle advice should you give to optimise chances of conception?

A 
stop smoking 
BMI normal range 
reduce alcohol and caffeine 
stop recreational drugs 
take folic acid
51
Q

what is the most common cause of ovulatory problems?

A

PCOS

52
Q

what is the name of the criteria used to diagnose PCOS?

A

Rotterdam diagnostic criteria

53
Q

when is PCOS diagnosed?

A

when the patient meets two of the Rotterdam criteria

54
Q

what are the elements of the Rotterdam criteria?

A

oligomenorrhoea/amenorrhoea
polycystic ovaries on USS
clinical and/or biochemical signs of hyperandrogenism

55
Q

what is classified as a polycystic ovary on ultrasound?

A

presence of 12+ 2-9mm follicles

increased ovarian volume >10ml

56
Q

what are three possible mechanisms for ovulation induction?

A

clomifene citrate
gonadotrophin injections
laparoscopic ovarian diathermy

57
Q

what is the first line option for ovulation induction?

A

clomifene citrate

58
Q

how is clomifene citrate administered?

A

50mg, 100mg and 150mg tablet over days 2-6 of the menstrual cycle

59
Q

what is an alternative to clomifene citrate for ovulation induction?

A

letrozole (tamoxifen)

60
Q

what are the possible risks of gonadotrophin injections?

A

multiple pregnancy

overstimulation

61
Q

what is a risk associated with laparoscopic ovarian diathermy?

A

ovarian destruction

62
Q

what can be done if a patient shows resistance to clomifene?

A

weight loss
adjuvant metformin
consider letrozole

63
Q

what can be done if a patient shows resistance to clomifene?

A

weight loss
adjuvant metformin
consider letrozole

64
Q

what bloods should be done if a male has abnormal semen parameters?

A

LH
FSH
testosterone

65
Q

what is the main treatment available if a male has abnormal semen parameters?

A

ART

66
Q

what are the three options for ART?

A

intrauterine insemination (IUI)

in vitro fertilisation (IVF)

intracytoplasmic sperm injection (ICSI)

67
Q

what are the possible options for management of tubal disease?

A

cannulation using a guide wire or micro catheter for proximal occlusion

generally no treatment - require IVF

68
Q

to be eligible for ART, how long must the relationship have been stable for?

A

at least two years

69
Q

to be eligible for ART, how old must the female be?

A

<40

70
Q

to be eligible for ART, what BMI must the female have?

A

18.5-30

71
Q

to be eligible for ART, how long must both partners have stopped smoking for?

A

at least three months prior to treatment

72
Q

to be eligible for ART, what criteria must both partners meet?

A

no biological child
no illegal substances
no sterilisation

73
Q

to be eligible for ART, how long must unexplained infertility have gone on for?

A

at least two years

Y3 Reproduction (49 decks)

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