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Endocrinology > Management of Infertility > Flashcards

Management of Infertility Flashcards

1
Q

what lifestyle changes can assist conception

A 
healthy diet 
weight loss (5-10%)/ gain 
stop smoking 
reduce/ stop alcohol (4 units a week)
moderate caffeine intake 
stop recreation drugs 
stop taking methodone
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2
Q

how can weight affect fertility

A

women- increased fertility problems and miscarriage rates,
decreased success with fertility treatments

men- increased DNA damage to sperm and erectile dysfunction

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3
Q

what advice should you give a couple trying to conceive

A

reassure- 84% conceive in year 1, 92% by year 2

advise sexual intercourse every 2-3 days

consider underlying psychosexual problems

consider preconception counselling

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4
Q

what is the lifetime of sperm

A

48 hours, increased by 3-5 days when gets nutrients from the cervix

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5
Q

what is the lifespan of an egg

A

24 hours

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6
Q

what vitamin supplements should you advise pre-conception

A

folic acid (reduces neural tube defects) - 400 micograms daily before pregnancy and throughout first 12 weeks (5 mg if history of neural tube defects or diabetes)

vit d - 10 micorgrams daily for pregnant or lactating women, or people in high risk population

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7
Q

how do you know if you have rubella immunity

A

rubella IgG antibodies

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8
Q

how long after rubella vaccinations before you can conceive

A

a month

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9
Q

what is characteristic of rubella syndrome (congenital rubella)

A

rash at birth, low birth weight, small head size, microcephaly, heart abnormalities (PDA), cataracts, bulging fontanelle

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10
Q

what treatment for women who are chlamydia positive

A

azithromycin 1 mg- if allergic doxyxcycline 100 mg for 7 days

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11
Q

what do irregular cycles usually indicate

A

oligomenorrhoea, anovulation

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12
Q

how many regular cycles are anovulatory

A

9%

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13
Q

what are the three types of ovulatory disorders

A

hypothalamic
hypoathalmic pituitary dysfunction
ovarian failure

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14
Q

what can cause hypothalamic ovulatory disorders

A

stress, excessive exercise, anorexia, kallmans syndrome, isolated gonadotrophin deficiency

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15
Q

what hormones are found in hypothalamic ovulatory disorders

A

low FSH, estrogen, normal prolactin, negative progesterone

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16
Q

what hormones are found in ovarian failure

A

high gonadotrophins with low estrogens

17
Q

what else can cause an ovulatory disorder

A

hyperprolactinaemia

18
Q

what causes type 1 ovulatory disorders (hypothalamic)

A

can be caused by any lesion affecting the pituitary or hypothalamus and affecting gonadotropin production
(hypogonadotrophiic hypogonadism)

19
Q

what most commonly causes hypothalamic pituitary dysfunction ovulatory disorders (who type 2) (normogonadotrophic hypogonadism)

A

most commonly caused by PCOS

20
Q

in what types of ovulatory disorders is induction of ovulation possible

A 
type 1 (hypothalamic)
type 2 (hypothalamic pituitary dysfunction)
21
Q

what is the best way to achieve conception in type 3 ovulatory disorders (ovarian failure)

A

oocyte donation (usually have follicular depletion)

22
Q

what are the reproductive surgeries for infertility treatment

A 
primary for infertility:
pelvic adhesions 
grade 1 and 2 endometriosis 
chocolate cyst in ovary 
tubal block

surgery to enhance IVF outcome:
laparoscopy
hyperoscopy

23
Q

what is tubal surgery

A

creating patency in the tubes

24
Q

what is a hydrosalpinx

A

blocked and distended fallopian tube

25
Q

what surgery for proximal tubal obstruction

A

salpingography plus tubal catheterisation

or

hysteroscopic tubal cannulation (when contraindications for above)

26
Q

what is the surgery for hydrosalpinges before IVF

A

salpingectomy (preferably laproscopy)

27
Q

what are the types of fibroids

A

pedunculated, subserous, intramural, submucous

Endocrinology (46 decks)

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