PBL1 - Subfertility Flashcards

1
Q

Primary sub fertility

A

No previous pregnancy

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2
Q

Secondary sub fertility

A

Previous pregnancy, whatever the outcome

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3
Q

Sub fertility incidence

A

15%

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4
Q

Female factors of subfertility (4)

A

Ovulation disorders
Tubal damage
Endometriosis
Cervical mucous hostility

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5
Q

Male factors for subfertility (1)

A

Disorders of sperm production or transport

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6
Q

Coital problems leading to subfertility:

A

Impotence
Dyspareunia (pain in sex)
Coital frequency of less than 3 times per week

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7
Q

Infertility - check men for …

A

Mumps orchitis

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8
Q

Physical examination of female look for (3)

A

Hirsutism
Pelvic tumour e.g. Fibroids, ovarian cysts
Genital abnormalities e.g. Rigid hymen, vaginal atresia

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9
Q

Physical examination of male look for (3)

A

Lack of virilisation
Small testicular size
Epididymal cysts
Varicoceles

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10
Q
Semen analysis:
Volume ...
.... million/ml density
... motility
Repeat tests .... Times, after each months interval
A

Volume 2-5ml
>15 million/ml density
>40% motility
Repeat tests 3 times, after each months interval

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11
Q

Ovulation tests:

3

A

Biphasic basal body temperature chart
Luteal phase plasma progesterone level - >30nmol/ml
Pulsatile LH secretion - peaks 36 hours before ovulation

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12
Q

Ovum survives for

A

24 hours

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13
Q

Sperms remains fertile for

A

72 hours

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14
Q

Assess tubal patency and pelvic assessed by… (2)

A

Ultrasound

Hysterosalpinography (X-ray and dye)

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15
Q

Postcoital tests / Kremer tests check for …

Aspirated when?

A

Cervical hostility - happens mid cycle

Cervical mucus is aspirated 12 hours after intercourse and checked for sperm numbers and motility

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16
Q

Oligomennorrhea

A

Irregular periods

17
Q

Most common cause of anovulatory infertility

A

PCOS

18
Q

PCOS cause (2)

A

Insulin resistance, leads to hyperinsulinaemia

Stimulate androgen production by theca cells in ovary

19
Q

Diagnostic criteria PCOS:

4

A

Infrequent / Absent ovulation
Hyperandrogenism (excessive hair, acne, raised LH and androgens)
Polycystic ovarian morphology on ultrasound - >12 follicles between 2-9mm in diameter, ovarian volume >10ml

20
Q

PCOS treatment: (3)

A
Weight loss
Ovulation induction by clomiphene
Wedge resection (surgery)
The pill
Anti-androgens e.g. Cryproterone acetate 
Metformin
21
Q

Induce ovulation with

A

Clomiphene

22
Q

Anti-androgen -

A

Cyproterone acetate

23
Q

Pelvic inflammatory disease - 2 main std’s

A

Chlamydia trachomatis

Neisseria gonorrhoeae

24
Q

PID leads to …

A

Scarring of ovaries and oviducts

Leads to narrowing / complete closure - infertility

25
Q

Before subfertility treatment check for

A

Rubella

26
Q

Treatment of ovulation failure (2)

A

Oral clomiphene citrate

Human menopausal gonadotrophins - injected daily

27
Q

Why must you monitor ovulatory treatment (2)

A

Reduce the risk of multiple pregnancy

Stop ovarian hyperstimulation syndrome

28
Q

Pregnancy rates per cycle for women under 40 are

A

25-30%

29
Q

Four cycles IVF success rates

A

60%

30
Q

Male infertility treatments

A
Intrauterine insemination (IUI)
Intracytoplasmic sperm injection (ICSI)
31
Q

Use IVF / IUI / ICSI after …. Of subfertility

A

2 years

32
Q

Subfertility

A

Defines as the inability to conceive for 12 months after regular unprotected regular intercourse