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3rd year > Repro - Infertility + contraception > Flashcards

Repro - Infertility + contraception Flashcards

1
Q

what is the definition of male infertility

A

infertility resulting from failure of the sperm to normally fertilise the egg

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2
Q

what are the types of male infertility

A

idiopathic = most common
obstructive = CF, infection, vasectomy
non-obstructive

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3
Q

give examples of genetic conditions which cause male infertility

A

Klinefelter’s syndrome
microdeletions of Y chromosome
Robertsonian translocation

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4
Q

what are the symptoms of obstructive male infertility

A

normal testicular volume
normal secondary characteristics
vans deferens may be absent

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5
Q

what are the symptoms of non-obstructive male infertility

A

low testicular volume
reduced secondary sexual characteristics
abnormal endocrine = high LH, FSH +/- low testosterone

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6
Q

what investigations should be if male infertility if suspected

A 
genital exam 
semen analysis 
endocrine profile
chromosome analysis 
CF screening 
if indicated:
   - testicular biopsy 
   - scrotal scan
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7
Q

what factors affect semen analysis

A

Completeness of sample – “any difficulties producing sample”
Period of abstinence e.g. less than 3 days
Condition during transport e.g. cold
Time between production and assessment e.g. deteriorates if after 1 hour
Natural variations between samples
Health of man 3 months before production

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8
Q

how many times should semen analysis be preformed

A

1st time then repeat 6 weeks later

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9
Q

what is the treatment of male infertility

A

treat specific cause = reverse vasectomy

anejculation conditions = psychosexual treatment

intracytoplasmic sperm injection

surgical sperm aspiration = azoospermia

donor insemination

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10
Q

what general advice should be given if male infertility is suspected

A 
Decrease alcohol (<4 units daily)
Stop smoking 
Lose weight (BMI <30)
Regular intercourse avoiding toxic lubricants
Avoid prolonged heat/chemical exposure
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11
Q

what is assisted conception treatment

A

any treatment which involves gametes outside the body

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12
Q

what are the indications for assisted conception treatment

A

Single
Same sex couple
Fertility preservation = Transgender, Cancer, Social reasons
Avoid transmission of blood born viruses between patients
Inherited disorder
Surrogacy when uterus abnormal/absent

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13
Q

what should be done before assisted conception treatment is started

A

lifestyle factors
folic acid = 3 months pre conception until 12 weeks
screen for disease = smear, bloods
assess ovarian reserve

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14
Q

assisted conception treatment can cause ovarian hyper-stimulation syndrome, what are the symptoms of this?

A

Mild = abdominal bloating/pain. Ovarian size <8cm

Moderate = abdominal bloating/pain, nausea +/- vomiting, ascites on U/S, ovarian size: 8-12cm

Severe = clinical ascites, oliguria, High K, low albumin and Na, ovarian size >12cm

Critical: thromboembolism, ARDS

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15
Q

how can ovarian hyper-stimulation be prevented

A

only low doses of HCG administered
Monitor = fluids, TED stockings, fragmin
Analgesia

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16
Q

what are the types of  assisted conception

A 
donor insemination 
intra-uterine insemination 
IVF
ICSI
fertility preservation 
surrogacy
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17
Q

what is intrauterine insemination

A

Prepared semen is inserted into the uterine cavity around time of ovulation

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18
Q

what is the indications for intrauterine insemination

A

sexual problems
same sex relationships
abandoned IVF
discordant blood virus

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19
Q

what are the indications for IVF

A

unexplained fertility
pelvic disease
anovulatory infertility after failed ovulation induction
failed 6 cycles of intrauterine insemination

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20
Q

what steps are involved in IVF

A

down regulation = reduced cancellation from ovaries

ovarian stimulation = FSH +/- LH to cause follicular development

Oocyte and sperm recovery

fertilisation

embryo transfer

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21
Q

what are the indications for Intra Cytoplasmic Sperm Injection (ICSI)

A

previous failed IVF
preimplantation genetic diagnosis
severe male infertility

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22
Q

what is the treatment of azoospermia

A

surgical sperm aspiration then ICSI

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23
Q

where is the sperm extracted from in ICSI

A

obstructive infertility = epididymis

non-obstructive = testicular tissue

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24
Q

what is an IUD, what is it also known as

A

aka copper coil

non-hormonal and long-lasting method of contraception

25
Q

what is the mechanism of action of the IUD

A

direct toxic effect causing endometrial changes and thinning

prevents fertilisation and implantation

26
Q

what are the contraindications to IUD

A

uterine pathology e.g. fibroids

unable to have surgery

27
Q

what are the side effects of IUD

A

surgical procedure

cain increase length/heaviness/pain of period

28
Q

what is an IUS

A

hormonal and long lasting method of contraception

29
Q

what is the mechanism of action of an IUS

A

endometrial changes, ovulation suppression, thickens cervical mucous

30
Q

what are the side effects of an IUS

A

spotting

amenorrhoea by 6 months

31
Q

what are the contraindications of an IUS

A

breast/cervical/ uterine cancer
liver disease
arterial disease/stroke/serious heart disease

32
Q

what is the subdermal contraceptive implant, what hormone does it contain

A

hormonal and long-lasting method of contraception

contains progesterone ONLY

33
Q

what is the mechanism of action of the subdermal implant

A

endometrial changes, ovulation suppression, thickens cervical mucous

34
Q

what are the side effects of the subdermal implant

A

prolonged pv bleeding - can co-prescribe combined pill

35
Q

what are the contraindications of a subdermal implant

A

breast/cervical cancer

arterial disease/stroke/serious heart disease

36
Q

when can you start the combined hormonal pill? what must be done for the 1st 7 days?

A

It can be started in first 5 days of period OR at any time in cycle if sure they are not pregnant

use condoms for the 1st 7 days

37
Q

what is the mechanism of action of the combined pill

A

endometrial changes and ovulation suppression

38
Q

what are the side effects of the combined pill

A

systemic hypertension
VTE
arterial disease
migraine with aura

39
Q

what must be checked while on the combined pill?

A

BP

check initially, at 3 months, then yearly

40
Q

what are the contraindications to the combined pill

A 
impaired absorption
liver disease 
breast/cervical cancer 
>35 years
high BMI 
arterial disease/stroke/serious heart disease
41
Q

when can the progesterone only pill be started? what must be used for the first 2 days?

A

It can be started in first 5 days of period OR at any time in cycle if sure they are not pregnant

use condoms for the 1st 2 days.

42
Q

what is the mechanism of action of the progesterone pill

A

ovulation suppression and thickens cervical mucous

43
Q

what are the side effects of the progesterone only pill

A

irregular bleeding

44
Q

what are the contraindications to the progesterone only pill

A

breast cancer

45
Q

when can the depo press/sayanna press/injections be given? what must be used for the first 7 days?

A

It can be started in first 5 days of period OR at any time in cycle if sure they are not pregnant

use condoms for the 1st 7 days

46
Q

what is the mechanism of action for the contraceptive injection

A

ovulation suppression, thickens cervical mucous, endometrial changes

47
Q

how does the contraceptive injection affect hormones

A

suppresses FSH

lowers Oestradiol

48
Q

what are the side effects of the contraceptive injection

A

takes a year for fertility to return to normal

osteopenia

49
Q

how can osteopenia be prevented when using the contraceptive injection

A

encourage calcium intake + weight bearing exercise

dexa scan indicated if they have been taking it for over 20 years

50
Q

what infections do NOT require contacting previous sexual partners

A

gentials warts
herpes
candidia
BV

51
Q

what STIs require you to contact all sexual partners within the last 4 weeks

A

Trichomonas vaginalis

Chlamydia if male urethral

52
Q

what STIs require you to contact all sexual partners within the last 6 months

A

chlamydia

PID

53
Q

how far far should you contact sexual partners with gonorrhoea

A

last 3 months except male urethral (past 2 weeks)

54
Q

how far far should you contact sexual partners with HIV

A

4 weeks before last negative test or before most likely time of infection

55
Q

how far far should you contact sexual partners with syphilis

A

primary - last 90 days
secondary - last 2 years
other - 3 months before last negative test

56
Q

what vaccines are given in sexual health clinics? who is eligible

A

Hep B = MSM, sexual assault, partner with it

Hep A = MSM

HPV = MSM, <46yrs old

57
Q

what is PEPSE? what conditions is it used for?

A

medication given AFTER exposure

Hep B and HIV

58
Q

what is the PEPSE for HIV

A

3 antiretrovirals started within 72hrs

treat for 28 days

59
Q

what is the PEPSE for Hep B

A

HBV for up to 7 days after exposure OR immunoglobulins for vaccine non-responders

3rd year (12 decks)

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