Physiology-Infertility Flashcards
Injecting contrast into the vagina and watching it outline structures into the peritoneum
Hysterosalpingogram
Why is ultrasound better than hysterosalpingogram? Why is it worse?
Better because you can see the myometrium. Worse because you can’t see the integrity of the uterine tubes.
What are these?
Hysteroscopy image of the ostea inside of the uterus that are the openings that enter the fallopian tubes
What do you typically utilize to analyze male infertility?
Semen sample looking for number (20 million), morphology (30% normal) and motility (50% motile).
What kind of fertility procedure to you do if the man has > 10 million motile sperm?
Intrauterine insemination.
What kind of fertility procedure to you do if the man has > 10 million motile sperm?
In Vitro Fertilization
What kind of fertility procedure to you do if the man has < 3 million motile sperm?
ICSI (direct sperm injection into egg)
MESA
Microsurgical Epididymal Sperm Aspiration
TESE
Testicular Sperm Extraction
Hydrosalpinx
Obstruction of the fallopian tube that prevents fertilization, destroys the tube and fluid can reflux into uterus and kill the embryo.
Criteria for diagnosis of polycystic ovarian syndrome
2 of 3: Ovulatory dysfunction, hyperandrogenism, polycystic ovaries.
What is PCOS?
Polycystic ovarian syndrome is characterized by many pearl sized follicles growing and dying with out ovulation.
PCOS treatment
Burn the stroma to decrease estrogen levels so ovulation can occur.
What factors can be used to predict diminished ovarian reserve?
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).
What happens if the central septum of the paramesonephric ducts fails to dissolve in utero?
Uterine didelphys, bicornuate uterus, unicornuate uterus, septate uterus.
How do you need to perform a hysterosalpingogram if a woman has a uterine didelphys?
Must inject beyond both cervices.
Why do you typically remove a septate uterus?
Successful implantation cannot occur on the fibrous septum because there is inefficient blood supply.
What is the most common cause of hysterectomy due to pelvic pain, pelvic pressure or bleeding?
Leiomyoma. Note that 70-80% of women have these (can be symptomatic or asymptomatic) by the end of their reproductive years.
Treatment of leiomyomas
Surgery, uterine artery embolization and hormonal therapy (anti-progestins, GnRH agonists, anti-estrogens)
What modality can you use to differentiate an endometrial polyp from a leiomyoma?
Nothing is great, the best way to know what it is is histeroscopy.
What is D&C a risk for infertility?
Synechiae, uterine scarring. Usually these are asymptomatic until they cover the cervix and cause cyclic pelvic pain with menses.
Why is hysterosalpingogram a good modality for diagnosing synechiae?
The die cannot cover & stain the uterine scarring.
