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OBGYN 2 > M4: Fertiliy Management > Flashcards

M4: Fertiliy Management Flashcards

1
Q

define infertility

A

inability to conceive after 12 month of unprotected sex

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2
Q

1 reason for infertility

A

postponement of preg until later years

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3
Q

ovarian causes of infertility

A

primary: ovulatory dysfunction
secondary: inability to transport ova/embryo due to block tube

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4
Q

uterine causes of infertility

A

congenital abnormalities
fibroids (impair vascular supply or blocking tubes)
ashermans

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5
Q

other causes of infertility

A

cervical

immunologic

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6
Q

cause of infertility in men

A 
varicocele
testicular faliure
tubular obstruction (vas deferens not connected to ED)
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7
Q

causes of testicular failure

A 
mumps
torsion
orchitis
cancer
cryptorchidism (increased temp impairs sperm)
marijuana use
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8
Q

what % of infertility is idiopathic

A

20%

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9
Q

when would ovulation induction be performed?

A

if the women has patent tubes w/ an ovulation impairment (doesnt produce a graafian follicle)

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10
Q

US roll in ovulation induction

A
  • routine pelvic US to monitor the cycle
  • track follicle growth (3 dimensions of the 3 largest follicles)

….trying to achieve 1 graafian follicle only

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11
Q

are fertility drugs used w/ ovulation induction

A

yes

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12
Q

if you see FF on the US, what does that typically mean in terms of the womans cycle

A

she has already ovulated

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13
Q

why is intrauterine insemination (IUI) typically done

A

due to male infertility issues
unexplained infertility
donor insemination
same sex couples

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14
Q

define in vitro fertilization

A

fertilization in a glass or lab, egg and sperm fertilized outside the body

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15
Q

reasons for IVF

A

blocked tubes
impaired eggs or sperm
unexplained infertility

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16
Q

steps for IVF

A
  1. lab and US investigation
  2. ovarian suppression of norm cycles
  3. ovarian stimulation (gonadotropins to hyperstimulate ovaries)
  4. egg retrieval
  5. insemination
  6. embryo transfer
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17
Q

is more than 1 egg produced w/ IVF

A

yes

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18
Q

what lab work is needed to IVF

A

bloodwork

Ovarian reserve testing… checks the FSH # which tells you about number of eggs left and ovarian age

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19
Q

FSH of < what number indicates eggs are present

A

<10

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20
Q

US use for IVF

A

assess uterus (fibroids, congenital abnorm)

adnexa (hydrosalpinx)

ovaries (PCOS, cysts, baseline antral follicle count)

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21
Q

what is baseline antral follicle count

BAFC < what # indicates poor ovarian response?

A

the number of sm antral follicles seen at the start of the menstrual cycle

<10

22
Q

what is a hysterosalpingogram (HSC)

what does it assess

A

xray, where dye or contrast in injected into the uterus

assess the uterus for congenital abnorm. and patency of tubes

23
Q

how can you tell the tubes are patent on a hysterosalpingogram

A

contrast will spill into the posterior cul de sac

24
Q

what is a sonohysterogram (SHG)

what does it assess

A

ultrasound guided procedure where saline is injected into the uterus

assess uterine cavity
patency of tubes

25
Q

is a sonohysterogram as reliable as a hysterosalpingogram for determining the patency of tubes

A

no

26
Q

complications of HSC and SHG

A

infection
fainting
spotting
radiation (HSC)

27
Q

describe ovarian suspension in IVF

A

downregulation - GnRH agonist is given to stop ovulation and creates a temp state of menopause… purpose is to prevent premature ovulation and controls timing of IVF cycle

28
Q

what is an ovarian suppression check

A

US to see that there are no new follicles developing

29
Q

how is the egg retrieved w/ IVF

A

under endovaginal guidance, needle inserted into vaginal wall and the egg is aspirated into a test tube…
… then examined for quality

30
Q

insemination w/ IVF

A

occurs in a petri dish through intracytoplasmic sperm injection

31
Q

w/ IVF, when is/are the embryo(s) transferred

A

day 3 or 5… day 5 is better to be able to assess implantation abilities

32
Q

factors that determine # of embryos implanted

A

mothers age
quality of embryos
previous fertility Hx

33
Q

why is ART often used?

A

due to previous ectopic that blocked a tube

34
Q

US use post IVF

A

confirmation of preg and # @ 6-8 weeks

35
Q

do you use any type of gel when doing an EV for ART

A

no, it may have spermicide

water only

36
Q

what is clomid

A
  • fertility drug that increases FSH and will simulate a norm cycle
  • only 1 graafian follicle produced
37
Q

what is pergonal

A
  • fertility drug that stimulates FSH and LH

- more than 1 graafian follicle produced

38
Q

what does a GnRH agonist do

A

shuts off pituitary

39
Q

describe ovarian hyperstimulation syndrome

A
  • can occur w/ fertility drug use… especially pergonal w/ hCG and pregnancy
  • creates theca luteal cysts
40
Q

what can ovarian hyperstimulation syndrome cause

A

ascites
pleural effusion
DVTs
shock or death

41
Q

what fertility drugs increases the chances of multiple gestations

A

pergonal - because multiple follicles develop

pergonal and hCG together - even higher chance than pergonal alone

42
Q

which drug is given on the day of, and immediately after, the transfer of the embryos w/ IVF

why

A

hCG, encourages implantation

43
Q

after embryo implantation w/ IVF, which drug is taken until 10 weeks gestation

why

A

progesterone

given until the placenta takes over

44
Q

why can IVF be unsuccessful

A
  • ovaries dont respond to hormones, no egg is produced
  • egg isnt fertilized or doesnt grow
  • failure to implant
45
Q

what is the most common reason that IVF is unsuccessful

A

failure to implant

46
Q

can good quality eggs be cryopreserved for later preg

A

yes

47
Q

what is GIFT

how does it work

A

gamete intrafallopian transfer

  • egg and spem are injected into the ampulla of the tube
  • done w/ EV or laparoscopy
48
Q

when is GIFT usually done

A

unexplained infertility or endometriosis….. considered more natural than IVF

49
Q

what is ZIFT

how does it work

A

zygote intrafallopian transfer
modified form of IVF

-1 day old zygotes placed in tubes

50
Q

theoretical advantage of ZIFT

A

embryo develops in the tube

OBGYN 2 (15 decks)

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