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Women's health trigger > Lecture 5: Infertility (enochs) + some > Flashcards

Lecture 5: Infertility (enochs) + some Flashcards

1
Q

Define infertility

A
  • Inability to conceive after 1y of unprotected intercourse of reasonable frequency in women < 35y
  • Inability after 6m for women > 35y

Primary = no prior para. Secondary = multips

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2
Q

What conditions tend to result in infertility?

A
  • Oligo/amenorrhea
  • Uterine/tubal/peritoneal disease
  • Stage 3/4 endometriosis
  • Known/suspected male infertility (varicocele)
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3
Q

What is the MCC of infertility?

A

Ovulator issues

Male is 2nd highest, so evaluate both partners!

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4
Q

what about gynecologic history can affect fertility

A
  • duration of infertility and any previous evaluation/treatment
  • menstruation details (frequency/changes/ovulatory signs)
  • prior contraceptive use
  • hx of ovarian cysts, endometriosis, leiomyomas, STDs, PID
  • hx of abnormal pap smears
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5
Q

What is conization?

A

Cone biopsy of cervix, which can affect cervical anatomy and decrease mucus quality

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6
Q

what about obstetric history is important in regards to assessing infertility

A
  • prior pregnancies
  • past pregnancy complications
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7
Q

what coital history is important when assessing infertility

A
  • frequency
  • timing (5 days prior to ovulation increases conception)
  • dyspareunia
  • lubricants (avoid oil based, used water based)
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8
Q

what medical history is important when assessing infertility

A
  • chemo
  • radiation
  • androgen excess = PCOS
  • thyroid disease
  • hyperprolactinemia
  • medications
  • BMI
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9
Q

What typically can cause recurrent pregnancy loss?

A
  • Monosomy X for spontaneous miscarriage
  • APS
  • Uterine abnormalities
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10
Q

What is the MCC of premature ovarian failure < 40y?

A

Turners

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11
Q

What is mittelschmerz?

A

Midcycle pelvic pain associated with ovulation

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12
Q

What are moliminal symptoms?

A

Breast tenderness, acne, food cravings, mood changes

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13
Q

How does basal body temperature change with ovulation?

A

Basal temp increase by 0.4-0.8F is strongly predictive of ovulation

(increased temp suggests POSTovulatory state)

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14
Q

How do ovulation predictor kits work?

A

Measuring urinary LH, since LH surge precipitates ovulation

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15
Q

WHy is FSH good to check ovarian reserve?

A
  • The less eggs you have, the less inhibin you secrete.
  • The less inhibin, the more FSH
  • FSH > 10 IU/L is associated with diminished ovarian reserve
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16
Q

what serum progesterone level is indicative of current ovulation

A

> 3

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17
Q

what are common etiologies of ovulatory dysfunction

A

hypothyrodism
hyperprolactinemia
diminished ovarian resevre (older w/o good eggs)
PCOS

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18
Q

if hyperprolactinemia is found in a patient with suspected ovulatory dysfunction, what is the next step of diagnostics? what is the teatment?

A
  • get head MRI just in case of mico/macroadenoma
  • tx w dopamine agonists (bromocriptine or cabergoline) or surgery
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19
Q

What does increased antimullerian hormone mean for follicle count?

A

More follicles

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20
Q

what is the treatment for women who have diminished ovarian reserve

A

ovulation induction
IUI/IVF
egg donor

21
Q

What is the initial treatment for anovulatory infertile women?

A

Clomiphene citrate (clomid)

22
Q

what is the MOA of clomiphene citrate (clomid)

A

estrogen antagonist -> results in increase in FSH levels which increase ovarian follicular activity.

given for 5 days starting on cycle day 2-5

23
Q

What does letrozole do?

A

Aromatase inhibitor, which inhibits the production of estrogen and increases FSH

24
Q

What is ovarian hyperstimulation syndrome?

A

Excessive exgenous gonadotropin therapy resulting in ovarian enlargement

Supportive tx

25
Q

Describe intrauterine insemination (IUI)

A
  1. wash/concentrate sperm
  2. Insert catheter into endometrial cavity and inject sperm
26
Q

Describe in vitro fertilization (IVF)

A
  • Direct injection of mature oocytes into endometrial cavity via sonographic evidence.
27
Q

What is a hyserosalpingogram used to image? (HSG)

A

Uterine cavity and tubal imaging via radio-opaque dye

28
Q

What is chromopertubation?

A

Injection of methylene blue thru cervical canal during laparoscopy to evaluate tubal patency

29
Q

Tx for tubal occlusion

A
  • Tubal cannulation
  • Tubal reconstruction
  • Tubal resection followed by IVF
30
Q

Tx for endometriosis

A
  • Surgical treatment (removal of adhesions and draining endometriomas)
  • IVF
  • GnRH
31
Q

Tx for pelvic adhesions

A
  • Surgical removal
  • IVF
32
Q

How do fibroids affect infertility?

A
  • Obstruction of tubes or distortion of uterus
33
Q

What is Asherman’s syndrome?

A
  • Intrauterine adhesions
  • Hx of D&C
34
Q

Dx and Tx of Asherman’s syndrome

A
  • Dx: HSG or hysteroscopy
  • Tx: Hysteroscopic lysis of adhesions
35
Q

Why is an endometrial biopsy preformed?

A

Thought to be more informative than just a serum progesterone level.

No longer routine

36
Q

What does high estrogen do to cervical mucus?

A

Thin and sticky

37
Q

what is a postcoital test

A
  • couple has intercourse on day of ovulation
  • women present to office few hours later and cervical mucus sample is obtained
  • mucus should stretch >5cm, have visible sperm, minimal inflammatory cells, and dry in a fern shape pattern.
  • if any of those dont happen, mucus may be inappropriate
38
Q

How long does it take sperm to mature?

A

90d, so any detrimental affect 3 months prior could be the culprit for male infertility

Sperm matures best at slightly below body temp

39
Q

what are the three causes of male infertility

A
  • abnormalities in sperm production
  • abnormalities in sperm function
  • obstruction of ductal outflow tract
40
Q

How is semen analysis performed?

A
  • Dont jack off for 2-3 days
  • Sterile cup collection
41
Q

How do you treat antisperm antibodies?

A

Corticosteroids

You will see agglutination on semen analysis

42
Q

low semen volume can indicate what

A
  • partial/complete obstruction of vas deferens
  • retrograde ejaculation
43
Q

what is oligospermia and how do you treat it

A

<20 million sperm / mL
tx: IUI

44
Q

what is azoospermia and what causes it

A
  • no sperm!
  • Congenital abscence of vas deferens (CF)
  • Severe infection
  • Vasectomy

Tx with donor or epididymal aspiration

45
Q

What is asthenospermia and causes and tx?

A
  • Decreased sperm motility
  • Prolong abstinence
  • Antisperm antibodies
  • Infection
  • Varicocele
  • Tx with intracytoplastic sperm injection or IUI
46
Q

What is teratospermia and Tx?

A
  • Abnormal morphology
  • Tx with IVF
47
Q

What might low FSH & low testosterone suggest in a male? Tx?

A
  • Kallmann syndrome: anosmia + hypogonadotropic hypogonadism
  • Idiopathic hypogonadotropic hypogonadism
  • Tx with gonadotropins!
48
Q

What might elevated FSH with low testosterone suggest?

A

Testicular failure resulting in oligosermia.

49
Q

What are the genetic causes of poor semen analysis?

A
  • Klinefelter syndrome (XXY)
  • Microdeletion of Y chromosome
  • CF

Women's health trigger (23 decks)

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