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Y4R5 - Gynecology I 👩‍🍼 > L11: Infertility - Pt 1 > Flashcards

L11: Infertility - Pt 1 Flashcards

1
Q

Def of Infertility

A
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2
Q

Types of Infertility

A
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3
Q

Types of Infertility

  • Primary
A

pregnancy never occurred before.

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4
Q

Types of Infertility

  • Secondary
A

pregnancy occurred before even once whatever its mode of termination.

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5
Q

Types of Infertility

  • Relative
A

ability of the patient to get pregnant but inability to maintain it till delivery.

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6
Q

Types of Infertility

  • Permenant (Sterility)
A

inability of the patient to get pregnant forever due to permeant cause.

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7
Q

Basic requirement for fertility

A
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8
Q

Basic requirement for fertility

  • Female
A
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9
Q

Basic requirement for fertility

  • Male
A
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10
Q

Etiology of Infertility

A
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11
Q

Etiology of Male Infertility

A
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12
Q

Etiology of Male Infertility

  • Congenital
A
  • Absent vas deferens OR duct obstruction.
  • Hypospadias OR epispadias.
  • Testicular hypoplasia OR crypt-orchidism.
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13
Q

Etiology of Male Infertility

  • Traumatic
A

Injury of the vas during repair of hernia.

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14
Q

Etiology of Male Infertility

  • Inflammation
A

Orchitis, prostatitis, STDs… etc

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15
Q

Etiology of Male Infertility

  • Neoplastic
A

Any neoplasm destructing testicular tissues.

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16
Q

Etiology of Male Infertility

  • Dysfunction
A
  • Failure of sperm deposition as in impotence, premature and retrograde ejaculations.
  • Abnormal spermatogenesis.
  • Abnormal seminal fluid or sperm motility.
  • Immunological factors e.g., antibodies against sperms.
  • Varicocele “its role is controversial”.
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17
Q

Etiology of Male Infertility

  • General Causes
A
  • Genetics
  • Smoking
  • Alcoholism
  • Liver cell failure
  • Idiopathic.
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18
Q

Dx of Male Infertility

A
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19
Q

Dx of Male Infertility

  • Hx
A
  • Age, job, and residence of the husband.
  • Previous marriage, and having or no previous child
  • History of diseases, trauma, surgery… etc..
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20
Q

Dx of Male Infertility

  • Ex
A

The cause may be detected e.g.:

  • loss of body hair, obesity, gynecomastia. varicocele, hypospadias, testicular hypoplasia.
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21
Q

Dx of Male Infertility

  • INVx
A
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22
Q

INVx in Male Infertility

A
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23
Q

INVx in Male Infertility

  • Semen Analysis
A
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24
Q

Value of Semen Analysis

A

The 1st investigation + most important done to evaluate infertile couple.

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25
Q

Physical Characters of Semen

  • Volume
  • Color
  • Odor
  • pH
  • Viscosity
  • Liquefecation
A
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26
Q

Microscopic Characters of Semen

  • Total Sperm Count
  • Sperm Conc.
  • Sperm Motility
  • Sperm Morphology
  • Sperm Viability
  • WBCs
A
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27
Q

Terms related to semen quality

A
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28
Q

If any abnormality in the semen is detected, …….

A
  • No treatment is given except after repetition of analysis in another lab.

“2 weeks later”

29
Q

INVx in Male Infertility

  • Others
30
Q

INVx in Male Infertility

  • Labs
A
  • CBC
  • Liver and renal functions
31
Q

INVx in Male Infertility

  • testicular Bx
A

In azoospermia

32
Q

INVx in Male Infertility

  • Culture
A

For infection

33
Q

TTT of Male Infertility

34
Q

TTT of Male Infertility

  • Medical
35
Q

TTT of Male Infertility

  • Surgical
A
  • Vein ligation in varicocele.
  • Treatment of hypospadias.
36
Q

TTT of Male Infertility

  • ART
37
Q

Etiology of Female Ovarian Infertility

38
Q

Etiology of Female Ovarian Infertility

  • Physiological
A

All causes of physiological amenorrhea.

39
Q

Etiology of Female Ovarian Infertility

  • Pathological
40
Q

Dx of Female Ovarian Infertility

41
Q

Dx of Female Ovarian Infertility

  • Symptoms
42
Q

Dx of Female Ovarian Infertility

  • Signs
43
Q

Dx of Female Ovarian Infertility

  • INVx
44
Q

INVx for Female Ovarian Infertility

  • Labs
45
Q

INVx for Female Ovarian Infertility

  • Imaging
A

U.S For serial measurements:
- Done to follow up the follicular growth and maturation.
“the mature Graafian follicle is about 18-25 mm”.

46
Q

INVx for Female Ovarian Infertility

  • Endoscopic Laparoscopy
A

For direct visualization of the stigma of ovulation.

47
Q

INVx for Female Ovarian Infertility

  • Histopathological
A

Premenstrual endometrial biopsy shows:
* No secretory changes.
* Luteal phase defect.

48
Q

TTT of Female Ovarian Infertility

49
Q

TTT of Female Ovarian Infertility

  • Correction of General Conditions
A
  • Treatment of general causes.
  • Treatment of hypothalamic and pituitary as in amenorrhea.
50
Q

TTT of Female Ovarian Infertility

  • Induction of Ovulation
51
Q

Induction of Ovulation in Female Ovarian Infertility

  • Medical
52
Q

Dose of Clomiphene citrate - Clomid

A
  • Used as 50 - 150 mg/day for 5 days starting from 2nd - 5th day of cycle for 6 months.
53
Q

Success Rate of Clomiphene citrate - Clomid

A

Ovulation rate is 70% & pregnancy rate is 40%

54
Q

What Causes lower Pregnancy Rate in Clomiphene citrate - Clomid?

A

It may be due to
- Antiestrogenic effect on cervical mucus & endometrium.
- Luteal phase defect.
- Improper coitus timing.
- Other undiagnosed factors of infertility.

55
Q

What Cuases Drug resistance to Clomiphene citrate - Clomid?

A
  • No documented ovulation after 6 months of treatment with the usual daily dose.
57
Q

Medical Induction of Ovulation in Female Ovarian Infertility

  • tamoxifen
A

As selective direct estrogen receptor inhibition.

58
Q

Medical Induction of Ovulation in Female Ovarian Infertility

  • Bromocriptine
A

As anti-prolactin in hyper-prolactineamia.

59
Q

Medical Induction of Ovulation in Female Ovarian Infertility

  • Metformin
A

As ant-insulin in PCOS.

60
Q

Induction of Ovulation in Female Ovarian Infertility

  • Surgical
A
  • Laparoscopic ovarian drilling (unilateral or bilateral).
  • Bilateral wedge resection (NOT used now).
61
Q

Def of Ovarian hyper-stimulation syndrome (OHSS)

A
  • It is a common complication of induction of ovulation as the ovaries may enlarge ≥ 12 cm with risk of peritoneal irritation OR ovarian rupture.
62
Q

CP / Grades of Ovarian hyper-stimulation syndrome (OHSS)

63
Q

CP / Grades of Ovarian hyper-stimulation syndrome (OHSS)

  • Mild
A

There is abdominal distension, pain, sickness and diarrhea.

64
Q

CP / Grades of Ovarian hyper-stimulation syndrome (OHSS)

  • Moderate
A

There may be excess fluid in the abdomen leading to more pain and discomfort.

65
Q

CP / Grades of Ovarian hyper-stimulation syndrome (OHSS)

  • Severe
66
Q

TTT of Ovarian hyper-stimulation syndrome (OHSS)

67
Q

Indications of using ovulatory drugs

68
Q

Pre-requisites for TTT with ovulatory drugs in infertility cases

Y4R5 - Gynecology I 👩‍🍼 (18 decks)

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