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Human Development > PBL 1: Subfertility > Flashcards

PBL 1: Subfertility Flashcards

1
Q

Define subfertility

A

Inability to conceive for 12 months after commencing unprotected regular intercourse

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2
Q

What types of subfertility are there?

A

Primary

Secondary

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3
Q

What are causes of subfertility?

A

Pelvic inflammatory disease
Endometriosis
Fibroids
PCOS

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4
Q

What are the three types of ovulatory causes?

A

T1: Hypopituitary failure -> anorexia
T2: Hypopituitary dysfunction -> PCOS, hyperprolactinaemia
T3: Ovarian Failure

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5
Q

What is PSCOS characterised by?

A

Mild obesity

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6
Q

What is diagnostic criteria for PSCOS?

A

Oligomenorrhea
Clinical hyperandrogenaemia
Polycystic ovaries on ultrasound

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7
Q

What is cause of PSCOS?

A

Insulin resistance -> hyperinsulinaemia -> androgen production theca cells

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8
Q

What is management for PSCOS if patient wishes to conceive?

A

Weight loss
Clomiphene
Surgery: ovarian drilling or wedge resection

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9
Q

What is management of PSCOS if patient does not wish to conceive?

A

Low dose contraceptive pills (restore menstrual regulatory)
Metformin
Anti-androgens

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10
Q

What does ovarian failure involve?

A

Persistent FSH raised

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11
Q

What is management of ovarian failure

A

Donor eggs

Alternative parenting

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12
Q

What are the tubdal and uterine causes of infertility?

A

Pelvis inflammatory disease
Endometriosis
Fibroids

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13
Q

What is pelvis inflammatory disease

A

Severe inflammation of the peritoneal cavity caused by infection spreading from the vagina and cervix to the uterus, oviducts, ovaries and pelvis area

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14
Q

How to diagnose PElvis inflammatory disease?

A

May be asymptomatic
Pelvis pain, dyspareunia, fever
Cervical excitation (painful cervix when touched)

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15
Q

What are causes of pelvic infalmmatory disease?

A

STIs such as chlamydia

gonorrhoea

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16
Q

How to manage pelvic inflammatory disease?

A

Antibiotics
rest
abstinence

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17
Q

What is endometriosis?

A

Presence of tissue histologically like endometrium outside the uterine cavity

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18
Q

How to diagnose endometriosis?

A

Pain
Dysmenorrhoea
Menorrhagia
Dyspareunia

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19
Q

How to manage endometriosis?

A

NDAIDs
COPC
GnRH Agonists
Surgery

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20
Q

What are fibroids?

A

Benign tumours of smooth muscle of myometrium

NOTE THE LOCATION OF FIBROIDS

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21
Q

Symptoms of fibroids?

A

Heavy regular periods
Menorrhagia
Dyspareunia

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22
Q

How to treat fibroids?

A 
COCP
LARCs
surgical
Radiological (embolisation)
Surgery (hysterectomy)
23
Q

What are male factors?

A 
Testicular
Azoospermia
Reversal of vasectomy
Ejaculatory problems
hypogonadism
24
Q

What are coital problems

A

Dyspareunia

Coital frequency <3 times a week

25
Q

What do you not offer in unexplained infertility?

A

Clomiphene as it does not increase chance of pregnancy/live birth

26
Q

After how many years do you offer IV?

A

2 years

27
Q

What drugs are linked to infertility in females?

A

Long-term NSAID use
neuroleptics
spironolactone
depo-provera

28
Q

What drugs are linked to infertility in men?

A

Anabolic steroids

chemotherapy

29
Q

What drugs are linked to both male and female infertility?

A

Chemotherapy

Illicit drugs

30
Q

How do you diagnose infertility in female (history wise)?

A 
Menstrual history
previous pregnancies
galactorrhoea
hirutism
previous contraceptive history
31
Q

What do you check for history wise in males to diagnose?

A

history of mumps orchitis
occupation e.g. excessive heat
abuse e.g. alcohol

32
Q

What do you examine for in female?

A 
endocrine/systemic diseases
hirsutism
pelvis tumours
fibroids
cysts
genital abnormalities
33
Q

What do you examine for in males?

A

endocrine/systemic diseases
lack of virilisation
small testicular size
epididymal cysts

34
Q

When do you perform semen analysis?

A

after 3 days of abstinence

to confirm abnormality, done 3 times. each after month’s interval

35
Q

What other tests can be done?

A 
Ovulation tests
basal body temperature chart
pulsatile LH secretion
Luteal phase plasma progesterone level
tubal patency + levic normality
postcoital/kremer tests
36
Q

How long must fertilisation occur after ovulation?

A

12-24 hours

37
Q

What do you check for in postcoital/kremer test?

A

Cervical hostility

38
Q

What do you check for in pulsatile LH secretion test?

A

Reach peak 36 hrs before ovulating

Determined in urine in simple homing testing kits

39
Q

What will luteal phase plasma progesterone level be to confirm subfertility?

A

> =30nmol/ml

40
Q

How does prempak-C mechanism of action work?

A

Includes oestrogen and progesterone

41
Q

What is it vital to ensure before treatment of subfertility?

A

Woman is immune to rubella

42
Q

How to treat ovulation failure?

A

Oral clomiphene citrate

if unsuccessful then use human menopausal gonadotrophins

43
Q

What do you monitor in treatment of female?

A 
Transvaginal ultrasound (observe follicular)
Serum oestradiol measurements to reduce risks of multiple pregnancies (ovarian hyperstimulation syndrome)
44
Q

What can be used 1st line for tubal subfertility?

A

Tubal microsurgery

45
Q

What is intraterine insemination

A

Sperm is separated in lab and there is removal of slower speed sperm before partner is inseminated

46
Q

When does insemination take place in IUI?

A

day 12-16

47
Q

What do you use to monitor IUI if using ovarian stimulating drugs?

A

ultrasound

48
Q

Who do you offer IUI to?

A

Ppl who can’t have intercourse
Required specific consideration (HIV)
Same sex relationships

49
Q

How many trials do you use IUI for before IVF?

A

12 cycles

50
Q

Who do you offer IVF to?

A

Women under40 who have not conceived after 2 yrs of unprotected intercourse
women 40-42 is never had IVF

51
Q

What is intracytoplasmic sperm injection

A

Single sperm injected directly into egg

52
Q

When is ICSI offered?

A

Severe deficits in sperm quality
Obstructive and non obstructive azoospermia
failure of IVF treatment

53
Q

What is post–code variation?

A

NHs funding for fertility treatment is very different dependent on where a person lives as the trusts make their own decisions

Human Development (8 decks)

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