Physiology-Infertility

Question 1

Injecting contrast into the vagina and watching it outline structures into the peritoneum

Answer 1

Hysterosalpingogram

Question 2

Why is ultrasound better than hysterosalpingogram? Why is it worse?

Answer 2

Better because you can see the myometrium. Worse because you can’t see the integrity of the uterine tubes.

Question 3

What are these?

Answer 3

Hysteroscopy image of the ostea inside of the uterus that are the openings that enter the fallopian tubes

Question 4

What do you typically utilize to analyze male infertility?

Answer 4

Semen sample looking for number (20 million), morphology (30% normal) and motility (50% motile).

Question 5

What kind of fertility procedure to you do if the man has > 10 million motile sperm?

Answer 5

Intrauterine insemination.

Question 6

What kind of fertility procedure to you do if the man has > 10 million motile sperm?

Answer 6

In Vitro Fertilization

Question 7

What kind of fertility procedure to you do if the man has < 3 million motile sperm?

Answer 7

ICSI (direct sperm injection into egg)

Question 8

MESA

Answer 8

Microsurgical Epididymal Sperm Aspiration

Question 9

TESE

Answer 9

Testicular Sperm Extraction

Question 10

Hydrosalpinx

Answer 10

Obstruction of the fallopian tube that prevents fertilization, destroys the tube and fluid can reflux into uterus and kill the embryo.

Question 11

Criteria for diagnosis of polycystic ovarian syndrome

Answer 11

2 of 3: Ovulatory dysfunction, hyperandrogenism, polycystic ovaries.

Question 12

What is PCOS?

Answer 12

Polycystic ovarian syndrome is characterized by many pearl sized follicles growing and dying with out ovulation.

Question 13

PCOS treatment

Answer 13

Burn the stroma to decrease estrogen levels so ovulation can occur.

Question 14

What factors can be used to predict diminished ovarian reserve?

Answer 14

Age, FSH (more is produced because of low estrogen feedback w/diminished ovarian function), anti-mullerian hormone (healthy granulosa cells produce this) and astral follicle count on U/S (< 4 = poor fertility).

Question 15

What happens if the central septum of the paramesonephric ducts fails to dissolve in utero?

Answer 15

Uterine didelphys, bicornuate uterus, unicornuate uterus, septate uterus.

Question 16

How do you need to perform a hysterosalpingogram if a woman has a uterine didelphys?

Answer 16

Must inject beyond both cervices.

Question 17

Why do you typically remove a septate uterus?

Answer 17

Successful implantation cannot occur on the fibrous septum because there is inefficient blood supply.

Question 18

What is the most common cause of hysterectomy due to pelvic pain, pelvic pressure or bleeding?

Answer 18

Leiomyoma. Note that 70-80% of women have these (can be symptomatic or asymptomatic) by the end of their reproductive years.

Question 19

Treatment of leiomyomas

Answer 19

Surgery, uterine artery embolization and hormonal therapy (anti-progestins, GnRH agonists, anti-estrogens)

Question 20

What modality can you use to differentiate an endometrial polyp from a leiomyoma?

Answer 20

Nothing is great, the best way to know what it is is histeroscopy.

Question 21

What is D&C a risk for infertility?

Answer 21

Synechiae, uterine scarring. Usually these are asymptomatic until they cover the cervix and cause cyclic pelvic pain with menses.

Question 22

Why is hysterosalpingogram a good modality for diagnosing synechiae?

Answer 22

The die cannot cover & stain the uterine scarring.