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SM Endocrine > Management of Infertility > Flashcards

Management of Infertility Flashcards

1
Q

What is the definition of infertility

A

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

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2
Q

Why is infertility classed as a disease

A

It causes considerable psychological distress

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3
Q

What are some factors that influence fertility

A

Female age
Duration of infertility
Previous pregnancy
Cause of infertility

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4
Q

What are some reasons for the incidence of infertility increasing

A 
Older women 
rise in increase in chlamydia infections 
increase in obesity 
increasing awareness of treatments 
change in expectations 
increasing male factor infertility
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5
Q

What should be involved in the examination of a female in the infertility clinic

A 
BMI
BP 
Urinalysis
General examination 
Pelvic examination
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6
Q

What should be involved in the examination of a male in the infertility clinic

A 
BMI
BP 
Urinalysis
General examination 
Urogenital examination
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7
Q

What type of drug can cause an increase in prolactin

A

Antidepressents

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8
Q

What types of drugs can cause a problem with Ovulation

A

NSAID

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9
Q

What investigations are required for the female

A

Endocervical swab for chlamydia
Cervical smear if due
Blood for rubella immunity
Midluteal progesterone level

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10
Q

What 3 things can Rubella syndrome cause to the newborn

A 
Microcephaly (small head)
PDA (heart abnormalities)
Cataracts 
Rash at birth 
Low birth weight
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11
Q

What type of vaccine is the Rubella vaccine

A

Live

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12
Q

What is the treatment for chlamydia

A

Azithromycin tablet 1g

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13
Q

What are some short-term affects of pelvic inflammatory disease

A

Tub-ovarian abscess
Peritonitis
Fitz-Hugh-Curtis Syndrome

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14
Q

What are some long-term affects of pelvic inflammatory disease

A

Chronic pelvic pain
Infertility
Ectopic pregnancy

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15
Q

What is the treatment for an ovarian abscess

A

Surgically drain the abscess and prescribe broad spectrum Antibiotics for 2 weeks

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16
Q

What is a strong suggestion of ovulation

A

Regular menstruation

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17
Q

What can we measure to confirm ovulation in someone with regular cycles

A

Midluteal serum progesteron

18
Q

What are the 3 groups of ovulatory disorders

A

Group 1 - Hypothalamic
Group 2 - Hypothalamic Pituitary dysfunction
Group 3 - Ovarian Failure

19
Q

What are some of the causes of Hypothalamic ovulatory disorders

A 
Stress 
Excessive exercise 
Anorexia
Kallman's syndrome 
Isolated gonadotrophin deficiency
20
Q

What is the most common type of ovulatory disorders

A

Hypothalamic pituitary dysfunction including PCOS

21
Q

What are some symptoms of PCOS

A 
Hirsutism
Acne/ oily skin
Increase in testosterone levels 
Oligomennorhoea
Central obesity
22
Q

What is seen on US to confirm Polycystic ovary

A

More than 12 follicles between 2-8 mm in diameter in a single plane

23
Q

Patients must have 2 of what to make a diagnosis of PCOS

A 
Irregular menstrual cycle, hirsuitism, acne, sub fertility, alopecia, obesity 
Biochemical- in days 2-5
Elevated serum LH 
LH/FSH >2 
Normal estradiol
Low progesterone
Normal or mildly elevated prolactin
Raised testosterone
24
Q

What are the first line drugs used to induce ovulation

A

Antioestrogens e.g. Clomifene citrate or tamoxifen

Aromatase inhibitors e.g. Letrozole

25
Q

How should Clomifene citrate be taken

A

Day 2-6 of cycle (1 tablet for 5 days)

26
Q

What is the advantage of using Tamoxifen to Clomifene citrate

A

The oestrogen effect on endometrium

27
Q

How do Aromatase inhibitors work

A

They inhibits ovarian aromatase enzyme

28
Q

What are some second line treatments for inducing ovulation

A 
Clomifene citrate + metformin (to improve sensitivity)
Gonadotrophin therapy (daily injections)
Laparoscopic ovarian diathermy
29
Q

What do we look for when examining sperm

A

Volume >1.5ml
count >15x 10^6/ml
Progressive motility and >4% normal morphology

30
Q

What is the most common cause of male infertility

A

Idiopathic

31
Q

What are some obstructive causes of male infertility

A

Vasectomy
Infection
Congenital absence of vas deferens (Cystic Fibrosis)

32
Q

What are some of the non-obstructive causes of male infertility

A

Undescended testis
Orchitis
Torsion/trauma
Chromosomal (Kleinfelter’s syndrome 47XXY)

33
Q

What are some other causes of male infertility

A

Hormone - hypothyroidism, hypogonadism, hypogonadotrophic, testicular cancer
Chemo, radio, erectile dysfunction, immunological

34
Q

What are the treatment options for male infertility

A

Surgery to obstructed vas deferins
Intrauterine insemination
Intracytoplasmic sperm injection (ICSI)
Donor insemination

35
Q

What are the most common causes of tubal disease

A

Infective:

Pelvic inflammatory disease inc. chlamydia or gonorrhoea

36
Q

What are some non-infective causes of the tubal disease

A 
Endometriosis 
Surgical 
Fibriods
Polyps 
Congenital
37
Q

What are the treatment options for tubal disease

A 
Tubal surgery (reversal of sterilisation)
IVF
38
Q

How are eggs collected for IVF treatment

A

Ultrasound guided

39
Q

How big is a blastocyst and at what stage does this form

A

More than 125 cells - blastocyst

40
Q

What are some general factors for improving the likelihood of pregnancy

A 
Sex 2-3 times per week 
Low alcohol intake 
Between 19-29 BMI 
No smoking 
Folic acid 
Rubella immunity 
Cervical smears up to date

SM Endocrine (27 decks)

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