Infertility + Insomnia Flashcards
Primary + secondary amenorrhea definition
Primary = no menarche by 16 or no secondary sexual characteristics + no menarche by 14
Secondary = no menses in 3mo with prev normal menstruation or no menses for 9mo in pt with prev oligomenorrhea
Differential?
Pregnancy
Hypothalamic dysfunction (low FSH, LH, estrogen)
Anorexia
Exercise
Stress
Nutritional deficit
Pituitary dysfunction
Brain tumor
Sheehan’s syndrome
Ovarian dysfunction
Menopause
Turner’s
PCOS
Endocrine
Hyperprolactinemia
Thyroid dz
Cushings
Questions to ask in history of amenorrhea
History
Sexual Hx
How long been trying
Coital frequency + timing
Lubricants
Menstrual hx
LMP
Cycle
Regularity
PMH
STI hx
Obs hx
Miscarriages
Past surgeries
Meds
Teratogenic meds
Prev contraeption
Stats for infertility
75% couples pregnant in 6 months
85% in 1 year
90% in 2 years
Causes: ⅓ male, ⅓ female, ⅓ combined
10% cases idiopathic
Lifestyle management of infertility
Folic acid
Smoking cessarion
Wt control
Avoiding alcohol
What to educate pts on?
Ovulation
Optimal intercourse timing (6d prior to ovulation q2-3d)
Reduced fertility with age
Adoption
Risk of pregnancy loss, chromosomal abnormalities, ASD, schizophrenia with increasing age
Ix for females
Rubella
Varicella
STIs inc HIV + hepatitis B + C
Day 3 LH/ FSH/ prolactin/ TSH/ estradiol/ testosterone
Day 21 progesterone
Pelvic US, HSG or hysteroscopy
Ix for males, and what further tests would you order if a) you found normal volume azoospermia and b) you were concerned for a tumor?
STIs inc HIV + hepatitis B + C
Rubella
Semen analysis
If normal volume azoospermia: LH, FSH, prolactin, estradiol
US if concerned for obstruction or tumors
Female causes
PCOS
Hyperprolactinemia (prolactinoma)
Thyroid disease
Cushings
PID
Adhesions
Prev ectopic
Uterine abnormality
Fibroids
Endometriosis
Male causes
Varicocele
STI
Mumps
TB
Klinefelters
Torsion
RT
Hernia repair
Drugs: cannabis
Rx to induce ovulation
Clomiphene citrate
Gonadotrophin
Metformin (PCOS)
Bromocriptine (for hyperprolactinemia)
Rx for males
Selective estrogen receptor modulators
Aromatase inhibitors
hCG
Testosterone
Surgical management for female
Tuboplasty
Lysis of adhesions
When to refer a couple
<35: after 1 yr trying
35-40: after 6mo
>40: immediately
Sx of PCOS
Hirsutism
oligomenorrhea
infertility
insulin resistance
acne
obesity
poly cystic ovaries
acanthosis nigracans
metabolic syndrome
PCOS is considered a risk factor for the potential development of…
Diabetes (through insulin resistance)
Endometrial Hyperplasia/Carcinoma (through unopposed estrogen excess)