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Endocrinology > Management of Infertility > Flashcards

Management of Infertility Flashcards

1
Q

What is infertility?

A

Failure to conceive despite regular unprotected sex over 12 months in absence of known reproductive pathology

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2
Q

Primary vs. secondary infertility?

A

Primary: couple never conceived
Secondary: couple previously conceived

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3
Q

Which infection associated with infertility?

A

Chlamydia

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4
Q

Test for chlamydia?

A

Endocervical swab

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5
Q

How do you check for rubella immunity?

A

Bloods

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6
Q

When do you check progesterone level when investigating infertility?

A

MIDLUTEAL PHASE
(day 21 of 28 day cycle, or 7 days prior to expected period in prolonged cycle)
MUST TAKE 2 SAMPLES

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7
Q

Progesterone over which level (nmol/l) is suggestive of ovulation?

A

> 30nmol/l

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8
Q 
Rash at birth
Low birth weight
Small head size
Heart abnormalities
Visual problems
Bulging fontanelles
A

Rubella syndrome

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9
Q

Microcephaly
Cataracts
Patent ductus arteriosus

A

Rubella syndrome

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10
Q

Short term complications of pelvic inflammatory disease (e.g. chalmydia)

A

Tubo-ovarian abscess
Peritonitis
Fitz-High-Curtis syndrome

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11
Q

Long term consequences of pelvic inflammatory disease?

A

Chronic pelvic pain
Infertility
Ectopic pregnancy

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12
Q

Fitz-Hugh-Curtis Syndrome?

A

upper quadrant pain (inflammation of liver capsule or diaphragm from spread of infection from pelvic inflammatory disease)

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13
Q

What is a hydrosalpinx?

A

Distally blocked fallopian tube filled with serous/clear fluid

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14
Q

Group I ovulatory disorders?

A

Hypothalamic

amenorrhea-includes stress, excessive exercise, anorexia, Kallman’s syndrome, isolated gonadotropin deficiency

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15
Q

Findings of group I ovulatory disorders

A

Low FSH, estrogen, normal prolactin, negative progesterone challenge

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16
Q

Group II hypothalamic pituitary dysfunction

A

Normogonadotrophic-normoestrogenic anovulation

e.g. PCOS

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17
Q

Group III ovulatory disorders

A

Ovarian failure

-high gonadotrophins with low estrogens

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18
Q

Which type of ovulatory disorder is PCOS?

A

Type II (hypothalamic-pituitary dysfunction)

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19
Q

Hysterosalpingogram

A

x-ray that examines the uterus and the fallopian tubes and the surrounding area

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20
Q

Commonest cause of anovulatory infertility?

A

Polycystic ovary syndrome

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21
Q

Increased ovarian volume?

A

> 10ml

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22
Q

How many follicles in PCOS?

A

More than 12 (between 2-8mm)

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23
Q

Diagnosis of PCOS (Rotterdam criteria)

A 
-Irregular menstrual cycle, hirsutism, acne, subfertility, alopecia, obesity, acanthosis nigricans
Biochemical: day 2 - day 5
-elevated serum LH (>10IU/L)
-LH/FSH ratio >2
-normal estradiol
-low progesterone
-normal or mildly elevated prolactin
-raised testosterone/FAI/A4
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24
Q

LH/FSH ratio in PCOS?

A

LH/FSH ratio >2

25
Serum LH in PCOS?
Elevated serum LH (>10IU/L)
26
Estradiol in PCOS?
Normal
27
Progesterone in PCOS?
Low
28
Testosterone in PCOS?
Raised
29
Clomifene citrate | Tamoxifen
Antioestrogens
30
Letrozole
Aromatase inhibitors
31
Ovulation induction: first line of treatment
Antioestrogens: clomifene citrate Tamoxifen Aromatase inhibitors: letrozole
32
How do you clomifene citrate (anti-oestrogens)
Monitor with tracking scan and serum progesterone
33
When do you give clomifene citrate?
Day 2- day 6 for 5 days
34
When do you give tamoxifen?
Day 2-6 for five days
35
Adverse effect of tamoxifen?
Estrogenic effect on endometrium
36
First line treatment for PCOS?
Anti-oestrogens: Clomifene citrate/tamoxifen | Aromatase inhibitors: Letrozole
37
Second line treatment for PCOS?
1) clomifene citrate + metformin 2) Gonadotropin therapy: daily injections (FHS and LH etc) 3) Laparoscopic ovarian diathermy
38
Investigating semen in men?
Semen analysis: twice over six weeks apart - If abnormal, do an endocrine profile - if SEVERELY abnormal --> do endocrine profile AND chromosome analysis and screen for cystic fibrosis, testicular biopsy
39
Most common cause of male infertility?
Idiopathic
40
Vasectomy, infection (e.g. chlamydia/gonorrhoea), congenital absence of vas deferens (e,.g. cystic fibrosis)
Obstructive causes of male infertility
41
Undescended testis, orchitis (e.g. mumps), torion/trauma, chromosomal (e.g. Klinefelter's syndrome) Kartagener syndrome, Y chromsome micro deletions
Non-obstructive causes
42
Hormonal causes of infertility?
Hypogonadotrophic hypogonadism Hypothyroidism Hyperprolactinemia
43
PESA
percutaneous epididymal sperm aspiration -you can also do percutaneous testicular sperm aspiration (both you put a needle in to take out the sperm)
44
MESA
Microsurgical epididymal sperm aspiration
45
When do you do hysterosalpingogram/laparoscopy & dye?
In the first 10 days of cycle -be careful in obesoty, previous pelvic surgery and Crohn's disease
46
Salpingitis isthmica nodosa?
Diverticulosis of the fallopian tube = nodular thickening of the narrow part of the uterine tube due to inflammation
47
Fibroids
Non-cancerous growths in the uterus
48
Treatment of tubal disease
Tubal surgery Selective salpingiogrpahy and catheterisation In-vitro fertilisation
49
How many times should you have sex?
2-3 times a week
50
How much alcohol should women drink?
Limit to 4 units per week
51
Optimal weight for fertility?
19-29
52
Folic acid for fertility?
0.4mg/day preconception till 12 weeks gestation
53
When would you do hysteroscopy?
Only performed in cases where suspected or known endometrial pathology: i.e. uterine septum, adhesions, polyp
54
When would you do pelvic ultrasound?
perform when abnormality on pelvic examination: e.g. enlarged uterus/adnexal mass when required from other investigations: e.g. possible polyp seen at HSG
55
What is endometriosis?
Presence of endometrial glands outside the uterine cavity
56
Symptoms of endometriosis
dysmenorrhoea, dysparenuia, menorrhagia, painful defaecation, chronic pelvic pain (severity of pain may be disproportionate to extent of disease)
57
Why does endometriosis affect fertility?
Reasons impaired infertility: anatomical damage (tubo-ovarian adhesions), dyspareunia, altered peritoneum environment (cytotoxic factors: impaired ovulation, lower embryo quality and impaired implantation)
58
Treatment for endometriosis?
Medical: combined oral contraceptive pill, progesterones (medroxyprogesterone acetate), GnRH agonists (zoladex +/- add back HRT) Surgical : Laparoscopic ablation/resection and adhesiolysis of mild disease Radical resection of severe endometriosis Drainage and ablation cyst base for endometriomas (consider prior to IVF) In-Vitro Fertilisation
59
Treatment of premature menopause
``` Counselling Fertility: oocyte donation Prevention osteoporosis (OCP, HRT Cryopreservation of ovarian tissue (prior to radiotherapy or chemotherapy) ```

Endocrinology (30 decks)

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