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ObGyn Lecture > Lecture 7- Infertility > Flashcards

Lecture 7- Infertility Flashcards

1
Q

What is fecundability and fecundity?

A
  • chances of becoming pregnant off of that one cycle.
  • probability of pregnancy resulting in live birth from one menstrual cycle
  • both decrease over time
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2
Q

What are examples of elective infertility?

A

Tubal ligation

Vasectomy

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3
Q

What is the definition of infertility?

A

Failure to achieve IUP > 12 months

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4
Q

What are some causes of unexpected infertility?

A

Wars, diagnosis of cancer, chemo

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5
Q

When will you bring down the infertility to less than 6 months?

A

> 35 y/o
history of oligo/amenorrhea
unknown uterine/pelvic factors
hx prior infertility

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6
Q

How many couples experience difficultly with conception?

A

15% of couples

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7
Q

What’s primary infertility?

A

Never fathered a child/ never been pregnant

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8
Q

What is secondary infertility in a female?

A

Has been pregnant before but now can’t get pregnant

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9
Q

What are three etiologies of female infertility?

A

Presence of ovulation cycles
HPG dysfunction and ovulatory dysfunction
Anatomic dysfunction

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10
Q

What are two different types of HPG dysfunction and ovulatory dysfunction?

A

Oligo-ovulation (not ovulating every cycle)

Amenorrhea

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11
Q

What are some things that can cause oligo-ovulation problems?

A

HPG dysfunction: thyroid
Pituitary: hyperprolactinemia
PCOS

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12
Q

What are some causes of Amenorrhea?

A

Pregnancy
Hyperandrogenism
stress related hypothalamic dysfunction
Premature ovarian failure

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13
Q

What does basal body temperature allow you to determine?

A

Time of ovulation; biphasic curve (due to rise with progesterone levels after LH surge)

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14
Q

When is LH present in the urine?

A

1 day before ovulation

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15
Q

What is the normal range for serum progesterone?

A

6-25

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16
Q

What progesterone levels are considered low?

A

3-5 ng/mL

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17
Q

Elevated prolactin- what should you look at if she isn’t pregnant?

A

Pituitary- look for prolactin secreting tumor

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18
Q

What hormone stimulates prolactin?

A

Thyroid releasing hormone

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19
Q

What shuts down prolactin secretion?

A

Dopamine

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20
Q

What are some things in the uterus that can lead to infertility?

A

Fibroids, leiomyoma, anomalous structure, polyps

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21
Q

What are some things in the fallopain tubes/ peritoneum that can cause infertility?

A 
Obstruction/ adhesions
PID
Appendicitis
Endometriosis
Priory surgery
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22
Q

With anatomic dysfunction what imaging diagnostics would be helpful?

A

TVUS (trans vaginal US)

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23
Q

What is cryptochidism?

A

Undescended testicle

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24
Q

WHat is hypospadias?

A

Urethral opening is lower down than normal

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25
Q

How many semen samples do you need for a proper analysis?

A

2 or 3 over 2 week period

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26
Q

How many days before giving a semen sample should males be abstient?

A

2-3 days

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27
Q

How much is normal volume of ejaculate volume?

A

1.5 mL

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28
Q

How many million sperm should you have per mL?

A

15 million

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29
Q

What percentage of the sperm should be mobile?

A

> 40%

30
Q

In primary hypogonadism what lab levels are abnormal in males?

A

Low testosterone

or elevated FSH, LH

31
Q

In males if there is low testosterone what should be checked?

A

Prolactin

32
Q

What day of the cycle do you want to draw FSH and estradiol?

A

cycle day 3

33
Q

What day do you want to draw serum progesterone?

A

Day 20, 21

34
Q

When do you start clomiphene citrate?

A

Cycle days 3-5 (follicular phase)

35
Q

When will ovulation occur after first dose of clomiphene citrate?

A

5-12 days after last dose

36
Q

What are some side effects of clomiphene citrate?

A

hot flashes, HA, nausea, 10% risk of multi-gestation pregnancy

37
Q

What type of drug is clomiphene citrate?

A

SERM, competes with estrogen

38
Q

how long is daily progesterone supplement given?

A

From oocyte retrieval through first 10 weeks

39
Q

What is a female with Male pattern distribution related to excess terminal hair? (coarse hair)

A

Hirsuitism

40
Q

What is Masculinization of a female d/t increased testosterone?

A

Virlization

41
Q

What are some ways that virilization manifests?

A 
Clitoral hypertrophy
Hirsuitism
Deepening voice
Remodeled muscle mass
breast atrophy
male pattern baldness
42
Q

What are common ddx for virilization?

A

PCOS
CAH
idiopathic (diagnosis of exclusion)

43
Q

What is treatment for hyperandrogenic disorders?

A

Supress or block action at receptor site

44
Q

What is the carrier protein that binds to testosterone?

A

SHBG (sex hormone binding globulin)

45
Q

Where is SHBG produced?

A

In the liver

46
Q

What stimulates SHBG production?

A

Estrogen

47
Q

Where are there testosterone receptors?

A

Hair follicles
Sebaceous glands
Genital skin

48
Q

What is constitutional hirsutism

A

increased of testosterone at target cells, not necessarily the increase in testosterone overall

49
Q

Individuals with PCOS who have acanthrosis nigricans often have what?

A

Insulin resistance

50
Q

In pCOS is estrone or estradiol present at higher levels?

A

Estrone

51
Q

What two blood levels are increased or upper limits of normal in PCOS?

A

Androstenedione and testosterone

52
Q

In PCOS what will TG levels be at?

A

150 mg/dL

53
Q

In PCOS what levels will HDL be at?

A

<50 mg/dL

54
Q

In PCOS, fasting blood glucose is greater than what?

A

> 100 md/dL

55
Q

On an US from someone with PCOS what will be seen?

A

1 or 2 ovaries w/ greater than o12 follicles (2-9 mm in diameter) see a lot of immature follicles

56
Q

In PCOS are there any variation in FSH or LH?

A

No, so there is no trigger for final development, ovulation of ovums

57
Q

What medication in PCOS helps decrease insulin resistance?

A

Metformin

58
Q

If a person has had sudden symptoms of rapid onset acne, hirsuitism, amenorrhea, virilzation what should you suspect?

A

Sertoli-Leydig tumor

59
Q

The deficiency of _________ is the most common cause of adrenal hyperplasia.

A

21-hydroxylase deficiency

60
Q

What accumulates when 21-hydroxylase is deficient?

A

Progesterone

17 alpha hydroxyprogesterone (17-OH_progesterone)

61
Q

What happens with the most severe form of 21-hydroxylase deficiency?

A

Female infant is virilized (ambiguous genitalia) and can suffer from life threatening salt wasting

62
Q

When 21-hydroxylase deficiency manifests at puberty what may precede thelarche?

A

Adrenarche

63
Q

What is treatment for CAH aimed at restoring?

A

Normal cortisol levels, usually supplement gluccocorticods like prednisone

64
Q

Can medical therapy for adrenal and ovarian disorders resolve hirsutism?

A

No, can only supress new hair growth

65
Q

What is a result of Cushing syndrome?

A

Adrenal excess as a result of adrenal neoplasm or an ACTH_producing tumor

66
Q

What is the name for hirustism where there is no explanation for the cause of the disorder?

A

Constitutional hirsutism

67
Q

Women with constitutional hirsutism have a greater activity of 5 alpha reductase and therefore more…

A

Free testosterone

68
Q

What is the most commonly used androgen blocker for constitutional hirsuitism?

A

Spironolactone

69
Q

What is when some drugs with androgen activity are implicated in hirsutism and virilization?

A

Iatrogenic androgen excess

70
Q

What is an attenuated androgen used for the suppression of pelvic endometriosis and can lead to iatrogenic androgen excess and hirsutism, acne, deepening of the voice?

A

Danazol

71
Q

For semen analysis, rapid progressive motility should be …

A

> 32%

72
Q

For semen analysis, normal morphology should be …

A

> 4%

ObGyn Lecture (21 decks)

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