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Reproductive System > Preventing & Treating Female Infertility > Flashcards

Preventing & Treating Female Infertility Flashcards

1
Q

is infertility a disease of male or female reproductive system or both

A

both

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2
Q

when should heterosexual women seek evaluation for female infertility

A

advise infertility evaluation if:
- no conception after 12 months of unprotected intercourse or donor insemination
- consider earlier evaluation for those aged 35yrs and older: if no conception within 6 months
- advise immediate infertility assessment for those ages 40 and older

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3
Q

when seeking evaluation for female infertility, what are 3 reasons why earlier evaluation is considered for women aged 35yrs and older (at 6 months of no conception)

A
  • due to expected decrease fertility with age
  • rising occurrence of conditions affecting fertility
  • increased likelihood of miscarriage
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4
Q

why is there an increased likelihood of miscarriage with older age

A
  • due to decrease in oocyte quality with rising age
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5
Q

in what circumstances should women also seek evaluation for female infertility

A

females with:
- oligomenorrhoea (infrequent menstrual periods - less frequent)
- amenorrhoea (absent menstrual periods)
- known or suspected tubal, uterine (including stage III or IV endometriosis), or peritoneal disease
- male partners with known or suspected male factor infertility

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6
Q

what is infertility caused by in 85% of infertile couples globally

A
  • identifiable alterations in expected physiology or underlying disease
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7
Q

top 3 most common causes of infertility

A
  • ovulatory dysfunction
  • male factor infertility
  • tubal disease
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8
Q

what is cause of infertility in remaining 15% of infertile couples

A

unexplained infertility

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9
Q

list 2 common infertility treatments

A
  • ovulation induction
  • ovarian stimulation
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10
Q

[treatments for female infertility] describe ovulation induction

A
  • pharmacological stimulation of ovulation
    -eg/ Clomiphene citrate, Letrozole
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11
Q

[treatments for female infertility] describe ovarian stimulation

A
  • stimulate multiple ovarian follicles and oocytes to mature <- thru FSH and LH
  • followed by ovulatory trigger - hCG
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12
Q

list & describe 2 fertilisation options following common fertility treatments

A
  • intrauterine insemination (IUI) during ovulation
  • in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) - requires retrieval of oocytes from ovary via ultrasound-guided needle
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13
Q

list causes of ovulatory dysfunction / anovulation

A
  • thyroid dysfunction or hyperprolactinemia
  • polycystic ovary syndrome (PCOS)
  • hypothalamic amenorrhoea
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14
Q

[ovulatory dysfunction / anovulation] diagnosis of thyroid dysfunction or hyperprolactinemia

A
  • diagnosis involves looking at serum markers for thyroid stimulating hormone (TSH) or prolactin
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15
Q

[ovulatory dysfunction / anovulation] treatment of abnormal TSH or prolactin ie/ thyroid dysfunction or hyperprolactinemia

A
  • correction of specific defect can result in resumption of ovulation
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16
Q

[ovulatory dysfunction / anovulation] diagnosis of polycystic ovary syndrome (PCOS)

A
  • looking at free and total testosterone levels in serum; looking at DHEAS (androgen derivative); looking at 17-OHP (progesterone derivative); transvaginal US (to find presence of multiple small ovarian follicles)
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17
Q

[ovulatory dysfunction / anovulation] treatment of polycystic ovary syndrome (PCOS)

A
  • ovulation induction
  • w timed intercourse or intrauterine insemination (IUI)
  • if obese, 15% loss of body weight can stimulate resumption of ovulation on its own
  • if above unsuccessful, in vitro fertilisation (IVF) should be considered
18
Q

[ovulatory dysfunction / anovulation] diagnosis of hypothalamic amenorrhoea

A
  • looking at serum levels of FSH, LH, oestradiol
19
Q

[ovulatory dysfunction / anovulation] treatment of hypothalamic amenorrhoea

A

treatment depends on if:
- hypogonadotropic hypogonadism - pulsatile GnRH therapy / gonadotrophin therapy
- hypergonadotropic hypogonadism - donor oocytes

20
Q

diagnosis of endometriosis

A

risk factors:
- early menarche
- short menstrual cycles
- heavy menstrual periods
- nulliparity (never had birth)
- family history of endometriosis
diagnosed by transvaginal ultrasound

21
Q

what can a delay in diagnosis of endometriosis lead to
is delay of diagnosis often for these patients

A
  • chronic pelvic pain
  • fatigue
  • anxiety and depression
    -> negatively impacting quality of life
    these patients often have delay in diagnosis
22
Q

treatment options for endometriosis are based on what 2 factors

A
  • severity of symptoms
  • if patient seeking to become pregnant
23
Q

treatment of endometriosis involves:

A
  • pain management
  • laparoscopic surgery sometimes
  • for fertility: ovulation induction w intrauterine insemination (IUI); if unsuccessful, consider IVF (in vitro fertilisation)
24
Q

outline what is involved in treatment of endometriosis for pain management

A
  • non-steroidal anti-inflammatory drugs (NSAIDs)
  • analgesics
  • GnRH-analogies
  • contraceptive (birth control) methods
25
Q

what is laparoscopic surgery used for in endometriosis

A
  • to remove endometriosis lesions, adhesions, scar tissues
26
Q

how are structural factors of tubal disorders, including blocked oviducts, diagnosed

A
  • hysterosalpingography (HSG) procedure inject dye at cervix
  • determine if passes thru reproductive tract & exits oviducts
27
Q

how are structural factors of tubal disorders, including blocked oviducts, treated

A
  • for bilateral blockage - surgical repair or ovarian stimulation [where oocytes removed from ovary] and IVF used
  • unilateral blockage - patients can usually still become pregnant without treatment
28
Q

how are structural factors of uterine factors including septate uterus, fibroids, polyps (congenital and benign uterine disorders) diagnosed

A
  • transvaginal ultrasound, 3D ultrasound, magnetic resonance imaging (MRI)
29
Q

how are structural factors of uterine factors including septate uterus, fibroids, polyps (congenital and benign uterine disorders) treated

A
  • surgery to correct uterine cavity defects
30
Q

causes of diminished ovarian reserve (have low number of follicles and oocytes)

A
  • advanced age
  • previous ovarian surgery (eg/ from cancer treatment)
  • family history of premature menopause
  • cancer treatment
  • fragile X premutation
31
Q

diagnosis of diminished ovarian reserve

A
  • serum markers including anti-mullerian hormone (AMH), FSH, oestradiol
  • ultrasound examination (look for number of antral ovarian follicles (growing follicles in ovary))
32
Q

how is diminished ovarian reserve prevented

A
  • fertility preservation (freezing oocyte / embryo) earlier in life or prior to gonadotoxic therapies
  • starting reproduction earlier to realise number of desired children
33
Q

how is diminished ovarian reserve treated

A
  • ovarian stimulated w intrauterine insemination (IUI) or IVF (in vitro fertilisation) <- these success rates decr with advancing age
  • for those w very diminished ovarian reserve - oocyte donation may be only option
34
Q

treatment option for unexplained infertility

A
  • suggested 3-4 cycles of ovarian stimulation w intrauterine insemination (IUI)
  • if these treatments not lead to pregnancy, consider IVF
35
Q

[lifestyle factors for fertility - exercise] what may disrupt menstrual cycles and ovulation resulting in infertility

A
  • extreme exercise or low body weight
36
Q

[lifestyle factors for fertility] a balanced lifestyle that supports reproductive health and optimal fertility involves what

A
  • nutrient-rich diet (incl incr folic acid, dairy intake, fruits, veges, wholegrains, seafood)
  • regular moderate exercise
  • overall well-being
  • maintaining healthy body weight
37
Q

what lifestyle factor is negatively associated with successful live births post-IVF & what advice is given

A
  • female obesity (BMI >30)
  • advised for obese women to seriously consider postponing conception to prioritise weight loss
38
Q

what should patients seeking to get pregnant aim for with tobacco, recreational drugs, and alcohol

A
  • avoid tobacco
  • avoid recreational drugs
  • consume no more than 2 alcoholic drinks per day
  • if pregnant, consume no alcohol
39
Q

what should patients seeking to get pregnant avoid environmentally due to toxins

A
  • avoid environmental pollutants and toxins - such as pesticides, heavy metals, workplace exposures
  • some plastics and cosmetic products contain chemicals that can negatively impact fertility - should be minimised or avoided
40
Q

what factors are success rates influenced by in fertility treatments

A
  • age
  • diagnosis
41
Q

what are physical ways couples can maximise conception chances

A
  • regular intercourse
  • esp during 3-day interval ending on ovulation day <- targets most fertile window of menstrual cycle

Reproductive System (21 decks)

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