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endocrine (mine) > Infertility Diseases > Flashcards

Infertility Diseases Flashcards

1
Q

what is infertility defined as

A

failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sex in a couple who have never had a child

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2
Q

what are the two types of infertility

A 
primary = never conceived
secondary = previously conceived but never carried ti term
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3
Q

what are the risk factors of infertility

A 
obesity 
chlamydia infection
old age 
smoking 
recreational drugs
high caffeine intake
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4
Q

what are the common cause of infertility in FEMALES (5)

A 
anorexia/bulimia 
endometriosis
PCOS
premature ovarian failure 
pelvic inflammatory disease
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5
Q

what hormone levels would you expect in anorexia/bulimia

A

low FSH
low LH
low oestrogen

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6
Q

what is endometriosis

A

presence of endometrial glands outside of the uterine cavity

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7
Q

what are the symptoms of endometriosis

A 
dysmenorrhoea (classically before menstruation) = painful cramps
dyspareunia = painful sex
menorrhagia = heavy period
painful defection
chronic pelvic pain
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8
Q

what are the investigations of  endometriosis

A

transvaginal US

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9
Q

what would you expect to see on US of endometriosis

A

“chocolate” cysts on ovaries

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10
Q

what are the symptoms of pelvic inflammatory disease

A 
abdominal/pelvic pain
vaginal discharge
dyspareunia = painful sex 
cervical excitation
menorrhagia & dysmenorrhoea
ectopic pregnancy
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11
Q

what basic things should be done for a FEMALE presenting with infertility

A 
test for chlamydia
cervical smear
bloods for rubella immunity 
midluteal progesterone level 
pelvic exam 
test tubal patency
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12
Q

what are the 2 methods of testing tubal patency

A

hysterosalpingogram

laparoscopy

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13
Q

when is a laparoscopy indicated

A

possible tubal/pelvic disease is suspected
previous pathology (e.g. ectopic pregnancy, ruptured appendix, endometriosis)
dysmenorrhoea
dyspareunia
previously abnormal hysterosalpingogram

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14
Q

when is a hysterosalpingogram indicated

A

no known risk factors of tubal/pelvic pathology

if laparoscopy is contraindicated

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15
Q

when would a laparoscopy be contraindicated

A

obesity
Crohn’s
previous surgery

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16
Q

when would you perform a hysteroscopy

A

suspected or known endometrial pathology e.g. uterine septum, adhesion, polyps

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17
Q

when would a pelvic US be preformed

A

if pelvic exam is abnormal

if further clarification is needed after a different test

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18
Q

what endocrine hormones are checked if hirsute

A

testosterone

SHBG

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19
Q

what endocrine hormones are checked if amenorrhoea

A 
Urine HCG
Prolactin
TSH
Testosterone and SHBG
LH, FSH and oestradiol
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20
Q

what other test is indicated if amenorrhoea

A

chromosome analysis

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21
Q

what endocrine hormones are checked if they have an anovulatory cycle or infrequent periods

A 
Urine HCG
Prolactin
TSH
Testosterone and SHBG
LH, FSH and oestradiol
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22
Q

what are the main causes of infertility in MALES

A

idiopathic (>60%)
drugs
non-obstructive
obstructive

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23
Q

give examples of non-obstructive causes of male infertility

A

47 XXY
chemo or radiotherapy
undescended testes

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24
Q

what hormone levels would you expect in a non-obstructive cause of male infertility

A

high LH
high FSH
low testosterone

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25
Q

what symptoms would make you suspect an non-obstructive cause of male infertility

A

low testicular volume
reduced secondary sexual characteristics
vas deferens present

26
Q

give examples of obstructive causes of male infertility

A

CF
infection
vasectomy

27
Q

what symptoms would make you suspect an obstructive cause of male infertility

A

normal testicular volume
normal secondary sexual characteristics
vas deferens may be absent

28
Q

what endocrine hormone levels would you expect in an obstructive cause of male infertility

A

normal LH
normal FSH
normal testosterone

29
Q

what investigations should you do for a MALE presenting with infertility

A

abdominal + testicular examination

semen analysis

30
Q

what is the next step if male examination is abnormal

A

scrotal US

31
Q

how is semen analysis done

A

twice, 6 wks apart

32
Q

what is the next step if semen analysis is abnormal

A 
measure: 
LH and FSH
Testosterone
Prolactin
Thyroid function
33
Q

what is the next step if semen analysis is severly abnormal/ azoospermic

A 
LH and FSH
Testosterone
Prolactin
Thyroid function
chromosome analysis 
screen for CF
testicular biopsy
34
Q

what is the treatment for male infertility

A

intrauterine insemination = in mild disease
intracytoplasmic sperm injection
donor insemination

35
Q

what is oligomenorrhea

A

cycles >35 days

36
Q

what is amenorrhea

A

absent menstruation

37
Q

what are the 2 types of amenorrhea

A 
primary = never had a period
secondary = had periods previously
38
Q

what are the 3 types of ovulatory disorders, which is most common

A

group 1 = hypothalamic pituitary failure
group 2 = hypothalamic pituitary dysfunction (85%)
group 3 = ovarian failure

39
Q

give an example of a group 2 ovulatory disorder

A

PCOS

40
Q

what are the causes of hypothalamic pituitary failure (Group 1)

A 
stress
excessive exercise/ low BMI/ anorexia 
tumour
head trauma 
drugs
41
Q

what are the symptoms of hypothalamic pituitary failure (Group 1)

A

amenorrhea
ovulatory disorders
hypogonadism

42
Q

what investigations are done in hypothalamic pituitary failure (Group 1), what would you expect to find

A

hormone levels = low FSH/ LH, normal prolactin

progesterone challenge test = negative

43
Q

what is the treatment for hypothalamic pituitary failure (Group 1)

A

get BM >18.5
gonadotrophin injections daily
US monitoring

44
Q

what is the treatment of  hypogonadotropic hypogonadism

A

pulsatile GnRH

45
Q

what are the symptoms of

Hypothalamic Pituitary Dysfunction (group 2)

A

normal oestrogen levels
oligo/amenorrhoea
PCOS

46
Q

what are the symptoms of PCOS

A 
Amenorrhoea (10-20%)
Oligomenorrhoea (80-90%)
Acne
Hirsutism
Central Obesity 
Insulin resistance (50-80%)
47
Q

what are the investigations of PCOS

A

High free androgens (Testosterone)
high LH
glucose tolerance test
US ovaries

48
Q

what would you expect to see on US in PCOS

A

polycystic ovaries:
12 or more 2-9mm follicles
Increased ovarian volume >10ml
Unilateral or bilateral

49
Q

what is the treatment of PCOS

A 
lifestyle change
folic acid 5mg daily
rubella immunity 
patency of tubes
ovulation induction
50
Q

what is the first line treatment in ovulation induction

A

clomifene citrate

51
Q

what can be given instead of clomifene citrate

A

tamoxifen

letrozole

52
Q

what increases sensitivity to clomifene citrate

A

metformin

53
Q

what is the 2nd line treatment in ovulation induction

A

gonadotrophin therapy

54
Q

what is the 3rd line treatment in ovulation

A

laparoscopic ovarian diathermy (drilling)

55
Q

what are the risks of IVF treatment

A

ovarian hyperstimulation

multiple pregnancy

56
Q

what is twin-twin transfusion syndrome

A

complication that arises in 10-15% of monochronicioc twins

57
Q

what is the cause of twin-twin transfusion syndrome

A

unbalanced vascular communications within the placental bed

58
Q

what is premature ovarian failure

A

menopause before 40

59
Q

what are the causes of premature ovarian failure

A

turner syndrome (46X)
fragile X syndrome
autoimmune disease
radio or chemotherapy

60
Q

what are the symptoms of premature ovarian failure

A

Hot flushes
night sweats
atrophic vaginitis
amenorrhoea

61
Q

what hormone levels would expect in premature ovarian failure

A

high FSH (>30 in 2 samples)
high LH
low oestrogen

62
Q

what is the treatment of premature ovarian failure

A

Hormone Replacement Therapy
Egg or Embryo donation (assisted conception treatment)
Ovary / egg / embryo cryopreservation prior to chemo
Counselling
Prevent osteoporosis

endocrine (mine) (12 decks)

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