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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
what blood tests are done if a female is amenorrhoeic or has cycles lasting longer than 42 days?
follicular phase bloods - LH, FSH, E2 testosterone SHBG prolactin
26
what initial investigation is done for infertility in males?
diagnostic semen analysis
27
what is azoospermia?
no sperm in ejaculate
28
what is asthenozoospermia?
% of progressive motile sperm is below the reference limit
29
what is the lower reference limit for sperm concentration?
16 x 10^6 per ml
30
what is the lower reference limit for sperm with progressive motility?
30%
31
what is the lower reference limit for sperm with normal morphology?
4%
32
what is oligozoospermia?
total number/concentration of sperm is below the reference limit
33
what is teratozoospermia?
the percentage of morphologically normal sperm is below the reference limit
34
what is oligoasthenozoospermia?
low count + low motility
35
what is oligoteratozoospermia?
low count + poor morphology
36
what is asthenoteratozoospermia?
low motility + poor morphology
37
what is oligoasthenoteratozoospermia?
low motility + low count + poor morphology
38
what two things need to be established as part of an infertility consultation?
length of the relationship | length of time trying to get pregnant
39
what three things are done for the female during an infertility consultation?
history examination/ultrasound investigations
40
what four things are done for the male during an infertility consultation?
history diagnostic semen analysis examination investigations
41
what can usually be seen on a transvaginal ultrasound?
uterus and ovaries uterine tubes usually not easily identified
42
what is hydrosalpinx?
fluid in the Fallopian tubes
43
what test is done to asses tubal patency?
hysterosalpingogram (HSG)
44
what is involved in an HSG scan?
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
what other investigation can be done to assess tubal potency if HSG is abnormal/contraindicated?
diagnostic laparoscopy and hydrotubation (HTB)
46
when is diagnostic laparoscopy and hydrotubation (HTB) chosen over HSG?
possible tubal/pelvic disease known previous pathology previously abnormal HSG
47
what is hysteroscopy used to look at?
the uterus
48
when is hysteroscopy performed?
when there is suspected or known endometrial pathology
49
what lifestyle advice should you give to optimise chances of conception?
``` stop smoking BMI normal range reduce alcohol and caffeine stop recreational drugs take folic acid ```
50
what lifestyle advice should you give to optimise chances of conception?
``` stop smoking BMI normal range reduce alcohol and caffeine stop recreational drugs take folic acid ```
51
what is the most common cause of ovulatory problems?
PCOS
52
what is the name of the criteria used to diagnose PCOS?
Rotterdam diagnostic criteria
53
when is PCOS diagnosed?
when the patient meets two of the Rotterdam criteria
54
what are the elements of the Rotterdam criteria?
oligomenorrhoea/amenorrhoea polycystic ovaries on USS clinical and/or biochemical signs of hyperandrogenism
55
what is classified as a polycystic ovary on ultrasound?
presence of 12+ 2-9mm follicles increased ovarian volume >10ml
56
what are three possible mechanisms for ovulation induction?
clomifene citrate gonadotrophin injections laparoscopic ovarian diathermy
57
what is the first line option for ovulation induction?
clomifene citrate
58
how is clomifene citrate administered?
50mg, 100mg and 150mg tablet over days 2-6 of the menstrual cycle
59
what is an alternative to clomifene citrate for ovulation induction?
letrozole (tamoxifen)
60
what are the possible risks of gonadotrophin injections?
multiple pregnancy | overstimulation
61
what is a risk associated with laparoscopic ovarian diathermy?
ovarian destruction
62
what can be done if a patient shows resistance to clomifene?
weight loss adjuvant metformin consider letrozole
63
what can be done if a patient shows resistance to clomifene?
weight loss adjuvant metformin consider letrozole
64
what bloods should be done if a male has abnormal semen parameters?
LH FSH testosterone
65
what is the main treatment available if a male has abnormal semen parameters?
ART
66
what are the three options for ART?
intrauterine insemination (IUI) in vitro fertilisation (IVF) intracytoplasmic sperm injection (ICSI)
67
what are the possible options for management of tubal disease?
cannulation using a guide wire or micro catheter for proximal occlusion generally no treatment - require IVF
68
to be eligible for ART, how long must the relationship have been stable for?
at least two years
69
to be eligible for ART, how old must the female be?
<40
70
to be eligible for ART, what BMI must the female have?
18.5-30
71
to be eligible for ART, how long must both partners have stopped smoking for?
at least three months prior to treatment
72
to be eligible for ART, what criteria must both partners meet?
no biological child no illegal substances no sterilisation
73
to be eligible for ART, how long must unexplained infertility have gone on for?
at least two years

Y3 Reproduction (49 decks)

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