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Reproductive System > Infertility - Women > Flashcards

Infertility - Women Flashcards

1
Q

When should a couple be referred to a fertility clinic?

A

Only if they’re been trying unsuccessfully for atleast 12 months or have other problems such as:

  • Irregular Periods
  • Relevant PMH
  • Testicular Problems
  • HIV/HEP B
  • Serious Anxiety >35s can be referred after only 6 months
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2
Q

List some of the major causes for Female Infertility?

A
  • Ovulatory Disorders
  • Androgen-secreting Adrenal Tumour
  • Prolactinoma
  • Fibroids
  • Endometriosis
  • Tumours
  • Tubal Block
  • Unexplained
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3
Q

What are the categories of ovulatory disorders?

A
  • Group I: hypothalamic pituitary failure (hypothalamic amenorrhoea or hypogonadotrophic hypogonadism).
  • Group II: hypothalamic-pituitary-ovarian dysfunction (predominately polycystic ovary syndrome)
  • Group III: ovarian failure (POI)
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4
Q

How would we treat someone with a Group 1 Ovulatory Disorder?

A
  • Optimise their BMI
  • Moderate exercise if they usually do high levels of exercise
  • Ovulation induction with GnRH or gonadotrophins with luteinising hormone activity
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5
Q

PCOS is the main Group 2 ovulatory disorder, what is it?

A

Polycystic Ovary Syndrome

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6
Q

How do we diagnose PCOS?

A

The Rotterdam Criteria - 2 out of 3 positive:

  1. Androgen excess (Ferriman Gallway Score) -
    1. Clinical (hirtuism) or biochemical (testosterone)
  2. Infrequent Periods (anovulation)
  3. Polycystic ovaries (on USS)
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7
Q

What signs would you look for to indicate androgen excess?

A
  • Hirsutism
  • Acanthosis Nigricans
  • Moderately raised testosterone (test DHEAS for androgen secreting tumours)

Score Androgen excess by a Ferriman Galway Score (1 to 4 for nine areas of the body)

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8
Q

How do we treat PCOS?

A
  1. Optimise BMI >18 and <35
  2. Ovulation induction with Clomifene or Gonadotrophins
  3. Weight loss/gain
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9
Q

How does Clomifene work?

A

Ovulation induction via;

  • Antagonises oestrogen receptors in pituitary
  • Causes hypothalamus to detect LOW oestrogen –> Hypothalmus stimulates increased secretion of FSH

GnRH –> FSH + LH –> E2 + P4

  • Use 50-150mg on days 2-6, prime with progesterone if amenorrhoeic
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10
Q

What must we be careful of when using clomifene?

A

Ovarian Hyperstimulation Multiple Pregnancy

Hence why we do Follicle Scanning in the 1st cycle and adjust the dose if required

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11
Q

When would we use Gonadotrophins to induce ovulation instead of clomifene?

A

If clomifene produces no ovulation or they do but they still don’t get pregnant. Up to 3-6 cycles using FSH injection.

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12
Q

How would you spot an androgen-secreting adrenal tumour?

A

Testosterone will be very elevated (much higher than in PCOS) DHEAS will be raised.

Follow up with an Adrenal CT.

Symptoms include Hirsutism and Acanthosis Nigricans

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13
Q

How would we treat a case of unexplained female infertility?

A

Don’t do ovulation induction (i.e. clomifene)

Just do IVF

Advise women with unexplained infertility who are having regular unprotected sexual intercourse to try to conceive for a total of 2 years (this can include up to 1 year before their fertility investigations) before IVF will be considered.

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14
Q

What can cause Tubal block?

A
  • Chlamydia
  • Tumour
  • Ectopic surgery
  • Sterilisation
  • Fibroid
  • Endometriosis
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15
Q

What kind of questions would we want to ask a woman when assessing fertility?

A
  • Duration of infertility
  • Past contraception
  • Past pregnancies complciations
  • Fertility in previous relationships
  • PMH
  • Menstrual history
  • Sexual history
  • Psychological assessment
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16
Q

What would you assess on a woman’s exam when thinking of infertility?

A
  • Weight
  • Height
  • BMI (kg/m2)
  • Fat and hair distribution
  • Galactorrhoea (prolactinoma)
  • Abdominal examination
  • Pelvic examination
17
Q

What baseline tests can be done outside a fertility clinic to assess fertility?

A
  • Rubella immunity?
  • Chlamydia?
  • TSH?
  • Ovulation?
  • Male partner’s semen analysis
18
Q

How do we test for ovulation?

A

If periods are regular: Mid luteal progesterone (7 days prior to expected period);

If periods are irregular: do day 1-5 FSH, LH, PRL, TSH, testosterone

19
Q

Once at a fertility clinic we can do futher tests for women, what do these include?

A
  • Pelvic US looking for Masses, structural abnormalities etc.
  • Tubal Patency test looking for Tubal Block
  • Ovulation tests looking for Ovulatory disorders like PCOS
20
Q

How do we test for tubal block?

A

Either with a HyCoSo (Hysterosalpingo-contrast-sonography) Or Laparoscopy

21
Q

What can we realistically offer an infertile woman?

A

Depends on the cause:

  • Ovulation induction for ovulatory disorders
  • Removal of androgen secreting tumours
  • IVF
22
Q

How does IVF work?

A

Harvest eggs from ovary to fertilise with sperm in lab ~5days incubation and then implant embryo using transfer catheter

23
Q

Intracytoplasmic Sperm Injection (ICSI) is another form of IVF, how does it work?

A

Injection of a single sperm into mature eggs instead of mixing the two in a lab and allowing for normal fertilisation

24
Q

What is the freezing of eggs known as?

A

Cryopreservation

25
Q

How does gonadotrophin therapy work?

A

Gonadotropins are identical to human pituitary FSH, so injecting them into the body will lead to stimulation of ovarian follicle growth.

26
Q

What is tubal factor infertility?

A

Tubal factor infertility occurs when diseases, damage, scarring or obstructions in the fallopiantubes prevent sperm from reaching the ovary to fertilise an egg, or prevents a fertilised embryo from reaching the uterus for pregnancy

27
Q

Before fertilisation treatment, what should be done about tubal block?

A

Surgery for hydrosalpinges (fallopian tube is blocked and fills with serous or clear fluid near the ovary (distal to the uterus)) before in vitro fertilisation treatment

Women with hydrosalpinges should be offered salpingectomy, preferably by laparoscopy, before IVF treatment because this improves the chance of a live birth.

28
Q

Define infertility

A

The inability of a couple to conceive after 12 months of regular intercourse without use of contraception.

29
Q

80% of couples in the general population will conceive within 1 year if:

A
  • The woman is aged under 40 years and
  • They do not use contraception and have regular sexual intercourse.

Reproductive System (26 decks)

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