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4 MBCHB > Repro 1 > Flashcards

Repro 1 Flashcards

1
Q

how can you define female infertility

A

12 months of unprotected sex and no baby

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2
Q

how can female causes on infertility be divided up

A

ovulating?
sperm?
pathway?

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3
Q

tests that can be done to assess ovulation

A

day 21 progesterone test

>30 is normla

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4
Q

other tests to assess infertility

A

sperm analysis

chlamydia. rubella. Hep B/C. HIV. ovarian reserve. pituitary hormones. testosterone

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5
Q

who is allowed to have IVF

A

<40 or 12 cycles of artificial insemination
40-42 12 cycles and no previous IVF, no evidence of low ovarian reserve and risks discussed
pelvic disease, anovulatory disease, genetic disease etc

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6
Q

what needs to happen before IVF treatment

A

alcohol <4 units per week. no smoking. weight BMI 19-29. folic acid 4g per day. smear. rubella. HIV. Hep B/C. chlamydia

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7
Q

IVF steps - just main ones 8

A 
down regulation 
baseline scan 
ovarian stimulation 
action scan 
sperm sample 
oocyte collection 
embryologist 
transfer
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8
Q

what happens during down regulation what is given and why

SE of whatever is given

A

buserlin - synthetic GnRH agonist as nasal spray/injection
to reduce cancellation from ovulation and impose success rate and to allow precise timing of oocyte recover by using HCG trigger
headaches, hot flushes, mood swings, nasal irritation

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9
Q

what happens during ovarian stimulation

SE

A

GnRH and FSH plus or LH given as daily S/C injection for 10-14 days to allow follicular development
mild allergic reaction. OHSS

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10
Q

what happens during the action scan - what if theres a slow response
what should be assessed for
what if normal

A

if slow response (40-50%) repeat scan 72 h
if poor response to FSH - increase dose
assess for OHSS
plan date/time for HCG injection

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11
Q

what should be done for the sperm sample and what is assessed

A

abstinence for 72 hours

motility, progression, volume, density

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12
Q

what bad things can happen during oocyte collection

what is it described as

A

bleeding, pelvic infection, failure to obtain

like a smear

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13
Q

embryologist dos what

A

finds eggs and incubates at 37 degrees

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14
Q

when does transfer occur

A

at d5 when its a blastocysts

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15
Q

what is given to patient and done after transfer

A

progesterone supplements (cyclogest) for 2 weeks and a UPT

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16
Q

what are the symptoms of OHHS

A

abdominal pain. ascites. N/V. ARDS. thromboembolism/ tense ascites

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17
Q

what is the treatment of OHSS

A

analgesia/ anti emetic. paracentesis. fluid balance. LMWH. admit.

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18
Q

when should IUI be done

A

unexplained infertility. mild/mod endom. mild male factor infertility

19
Q

what happens during IUI

A

in natural/stimulated cycle prepared semen inserted at time of ovulation to increase the number of sperm that reach the fallopian tubes

20
Q

what is ICSI done

A

failed IVF. severe male factory infertility. pre implantation genetic disease

21
Q

how is ICSI done

A

extract from epididymis if obstructive, testicular tissue if not. egg stripped (obtained via IVF). sperm immobilised and injected. incubate at 37 degrees

22
Q

success created for IUI

ICSI

A

10% per cycle

30% per cycle

23
Q

causes of male infertility (3)

A

idiopathic. obstructive. non-obstructive

24
Q

obstructive causes

A

CF, vasectomy, infection

25
Q

non obstructive causes

A

cryptochordism, mumps, orchiditis, chemo/radio, tumour, klinefelters, semen abnomarlities, systemic, endocrine

26
Q

normal testicular volume in pre pubertal
pubertal
abnormal

A

1-3mls
12-25
<5

27
Q

what is done on semen analysis

A

volume, density, morphology, progression

28
Q

if semen analysis is positive why should it be done again nd when

A

3 months later: health, completeness of sample, period of abstinence, condition and time between transport, production and assessment, natural variation between samples

29
Q

results of investigations done on obstructive

A

normal testicular volume and normal secondary sexual characteristics
normal LH/FSH/testosterone
VD may be missing

30
Q

NO examination results

A

abnormal testicular volume (low) and decreased secondary sexual characteristics, VD present, increased FSH/LH, decreased testosterone

31
Q

treatment of male infertility

A

frequent sex, alcohol <4 units per week, no smoking/caffiene, avoid tight baths, hot baths/saunas, avoid tight fitting pants, anti oxidants (vitc/zinc), IUI, ICSI, aspiration, donor insem

32
Q

when is sperm aspiration done and success rates and what is done after

A

azoospermina
surgically
NO 50% and 95% in obstructive
ICSI

33
Q

donor insemination success rate

A

15% per cycle

34
Q

what is cryptochordism and how does it affect fertility

A

undescended testes

reduces sperm count but if unilateral still fertile

35
Q

treatment for cryptochordism

A

orchidopexy in <1s to reduce risk of cancer

orchidotomy in adults

36
Q

androgen insensitivity syndrome geentics

A

congenital insensitivity to androgens
AR
46XY

37
Q

pathology of androgen insensitivity syndrome

A

androgen induction of wolffian duct does not occur but mullerian inhibition does

38
Q

symptoms and signs of androgen insensitivity syndrome

A 
born phenotypically female - absence of uterus and ovaries and short vagina
primary amen
lack of pubic hair 
breast development 
undescended testis
39
Q

test for androgen insensitivity syndrome

A

buccal smear - chromosome analysis

40
Q

treatment for androgen insensitivity syndrome

A

counselling - raise kid as girl
orchidectomy
oestrogen therapy

41
Q

klinefelters syndrome geneticd

A

47XXY

42
Q

clinical presentation of kilnefelterrs

A

tall, lack pf pubic hear, gynacamastia, infertility, decreased facial and body hair, small and firm testes, increased FSH and LH

43
Q

ix for klinefelters

rx

A

chromosome analysis

testosterone therapy

44
Q

tubal infertility causes
investigations
treatment

A

chlamydia. PID. anatomical
if history of PID - laparoscopy and dye hydrotubation
HSG.
if bilateral tubal dx- IVF

4 MBCHB (80 decks)

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