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OB > Infertility Issues > Flashcards

Infertility Issues Flashcards

1
Q

definition of infertility

A

inability to conceive after 12 months of frequent, unprotected intercourse

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2
Q

what can cause infertility?

A
  • female factor (40%) or male factor (20%)
  • combo/unexplained
  • delayed childbearing (inc. age)
  • weight
  • STI
  • stress
  • smoking
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3
Q

how long should couples who are trying to conceive participate in intercourse?

A

every other day

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4
Q

what cycle days are most fertile?

A

7-17

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5
Q

what hormones may be tested for in women

A

gonadotropin, FSH, LH, progesterone, prolactin, TSH, androgen levels

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6
Q

when is FSH tested?

A

day 3

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7
Q

when is LH tested?

A

mid cycle, indicated ovulation

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8
Q

when is progesterone tested?

A

day 21

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9
Q

what are cervical mucus changes caused by

A

estrogen as ovulation approaches

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10
Q

what is spinbarkheit

A

mucus elasticity, indicating ovulaton

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11
Q

what is the crystallization of dried mucus under a microscope

A

ferning

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12
Q

what are anti sperm antibodies

A

made by cervix to immobilize sperm

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13
Q

describe ideal cervical mucus

A

thin, clear, watery, profuse, alkaline

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14
Q

what provides information about the receptivity of the endometrial lining and the effects of progesterone after ovulation

A

endometrial biopsy

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15
Q

what is used to assess development of follicles, endometrial development. it is indicated during ovulation induction, timing for insemination and intercourse, invitro fertilization, and early pregnancy

A

transvaginal ultrasound

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16
Q

what is when dye is placed and the uterine structure and patency of fallopian tubes are assessed?

A

hysterosalpingogram

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17
Q

what assesses uterine structire and allows for further uterine assessment of size, shape, and location of uterine cavity

A

hysteroscopy

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18
Q

what procedure is visualization of pelvic organs

A

laparoscopy

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19
Q

what does a laparoscopy look for?

A

endometriosis, adhesions, adhesions, pelvic inflammatory

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20
Q

what is dilation of scrotal veins (big cause of male infertility)

A

varicocele

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21
Q

what are causes of male infertility

A
  • varicocele
  • testicular atrophy
  • absence of vas deferens (congenital)
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22
Q

what is the normal sperm volume

A

greater than 2 ml

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23
Q

what is the normal sperm pH

A

7 to 8

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24
Q

what is the normal sperm count

A

greater than 20 million / ml

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25
Q

what is the normal sperm liquefaction?

A

complete in 1 hour

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26
Q

what is the normal sperm motility

A

50% or more move forward

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27
Q

what are the normal forms of sperm

A

30% or greater

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28
Q

what is involved in semen analysis?

A
  • oligospermia
  • azoospermia
  • antisperm antibodies
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29
Q

what is semen with low concentration of sperm?

A

oligospermia

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30
Q

what is imparied or nonexistant sperm production

A

azoospermia

31
Q

what may be present d/t impairment in blood/testes barrier

A

antisperm antibodies

32
Q

what med induces ovulation through stimulation of the hypothalamus to produce more FSH and LH

A

clomid

33
Q

what is the route of administration for gonadotropins (repronex, menopur, follistim, gonal-f)

A

IM/SQ

34
Q

what do gonadotropins contain?

A

FSH&LH

35
Q

what are gonadotropins used for?

A
  • anovulatory women with low/normal levels
  • pts who can’t conceive with clomid
  • pts undergoing assisted reproduction
36
Q

what needs to be monitored while on gonadotropins

A
  • hyoerstimulation, multiple pregnancy
  • follicle development
37
Q

when is hCG administered to stimulate ovulation?

A

when follicles are mature

38
Q

when should patients who receive gonadotropins and hCG have intercourse

A

24-46 later and for the next 2 days

39
Q

what is luteal phase defect caused by?

A
  • poor follicle maturation
  • premature demise of corpus luteum
  • lack of endometrial response to progesterone
  • low progesterone levels are associated with FSH in the proliferation phase
40
Q

what pharm agent is used for luteal phase defect?

A

progesterone

41
Q

when is progesterone administered for luteal phase defect and what does it do

A
  • it is administered after cHG in ovulation induction cycle
  • it increases endometrial receptivity to implantation
42
Q

which infertility med inhibits the pituitary’s secretion of prolactin and is used for anovulatory patients who have high levels of prolactin (dec. FSH&LH)

A

parlodel

43
Q

what are side effects of parodel

A

teratogenic!!!
* nausea, diarrhea, dizziness, HA, fatigue

44
Q

anovulatory women with PCOS have what realtion with insulin?

A

hyperinsulinemia

45
Q

what med is used for anovulatory women with PCOS?

A

insulin sensitizing agents (metformin)

46
Q

what is the presence of endometrial tissue outside of the uterus

A

endometriosis

47
Q

what med suppresses ovulation and menstruation to allow atrophy of endometrial tissue (endometriosis)

A

danazol

48
Q

what 2 meds are used for treatment of endometriosis?

A

danazol and oral contraceptives

49
Q

what med stimulates and releases eggs through stimulating hypothalamus, produces FSH&LH

A

clomid

50
Q

what med directly stimulates follicle development

A

gonadotropins

51
Q

what med triggers ovulation

A

hCG

52
Q

what med prepares endometrial lining and maintains pregnancy

A

progesterone

53
Q

what med inhibits secretion of prolactin, allowing production of FSH and LH

A

parlodel

54
Q

what med settles endometriosis

A

danazol

55
Q

what med controls hyperinsulinemia in women with PCOS

A

metformin

56
Q

what is placement of sperm at the cervical opening

A

therapeutic insemination

57
Q

why would donor sperm be used in therapeutic insemination

A
  • sperm quality
  • single woman
  • lesbian couple
58
Q

how lon gis donor sperm frozen and quarantined for?

A

6 months

59
Q

what is IVF

A

after trying infertility meds, eggs are extracted from ovaries and fertilized with sperm in a lab. embryos are transferred to uterus 1-5 days later

60
Q

is IVF expensive?

A

yes

61
Q

what is storage of extra embryos, may be thawed in future

A

embryo cryopreservation

62
Q

how many embryos are placed in IVF for greatest chance of pregnancy?

A

3-4

63
Q

what is when eggs are collected with ultrasound guidance. eggs and sperm are transferred separately into fallopian tube

A

gamete intrafallopian transfer (GIFT)

64
Q

what is the rationale for GIFT?

A

may be more accepted in religions

65
Q

what is when eggs are collected with ultrasound guidance, fertilized with sperm in a lab, then placed in fallopian

A

ZIFT

66
Q

how does ZIFT differ from IVF?

A

ZIFT = fallopian
IVF = uterus

67
Q

is GIFT or ZIFT more effective?

A

ZIFT

68
Q

what is when sperm are sorted and desired sex is used in insemination or IVF

A

sperm sorting

69
Q

what is rationale for sperm sorting?

A
  • chromosomal abnormalities associated with sex
  • 2 or more children of same sex and want diff
70
Q

what is when a woman is contracted to carry the pregnancy for a couple that is not genetically their own

A

gestational carrier

71
Q

what is a gestational carrier and oocyte (egg) donor?

A

surrogate

72
Q

what is a specialized procedure where sperm quality or morphology is of concern, genetic conditions, or prior IVF was unsuccessful?

A

intracytoplasmic sperm injection (ICSI)

73
Q
A
74
Q
A

OB (19 decks)

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