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Endocrine > Reproduction > Flashcards

Reproduction Flashcards

1
Q

How long is a typical menstrual cycle?

A

28 days

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2
Q

What is classed as day 1 of the menstrual cycle?

A

The first day of bleeding

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3
Q

What hormones peak at day 14?

A

LH

This occurs just before ovulation

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4
Q

In the first half of the cycle, what hormone(s) is/are produced?

A

Oestrogen only

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5
Q

In the second half of the cycle, what hormone(s) is/are produced?

A

Oestrogen and progesterone

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6
Q

When does an embryo begin to secrete HCG?

A

When it has been implanted.

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7
Q

What is the role of oestrogen and progesterone?

A

To develop the uterine wall sufficiently to give implantation the greatest chance of success.

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8
Q

As an implanted embryo continues to develop, what hormones does it produce?

A

Human placental lactogen
Placental progesterone
Placental oestrogen

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9
Q

What does the release of placental progesterone and HPL do to insulin resistance levels?

A

Increases them.

A physiological process to ensure growing baby gets nutrients it requires. However can be problematic level of resistance already present in mother - causes gestational diabetes.

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10
Q

Are ACE inhibitors and statins safe to continue in pregnancy?

A

No - they are teratogenic.

If BP management needed, give labetalol.

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11
Q

What is a recommended therapy in ANY pregnancy deemed to be high-risk?

A

150mg of aspirin daily after 12 weeks of pregnancy.

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12
Q

How should levothyroxine dose be altered during pregnancy?

A

Increase by 25ug

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13
Q

What are high hCG levels associated with?

A

Vomiting

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14
Q

What are the reproductive hormones?

A

GnRH
LH
FSH
Oestrogen
Progesterone
Testosterone

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15
Q

What is the role of FSH in males?

A

Causes spermatogenesis in the testes.

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16
Q

What is the role of FSH in females?

A

Causes the growth of ovarian follicles, and also plays a role in the ovary secreting oestrogen.

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17
Q

What is the role of LH in males?

A

Causes testosterone production at the testes (and then helps FSH to stimulate spermatogenesis).

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18
Q

What is the role of LH in females?

A

Causes ovulation, and progesterone production from the corpus luteum.

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19
Q

What is the corpus luteum?

A

The ovulated follicle.

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20
Q

Where is GnRH produced?

A

Hypothalamus

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21
Q

Where are LH/FSH produced?

A

Anterior pituitary

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22
Q

What is the role of progesterone?

A

It is a pro-gestation hormone, that increases the likelihood of implantation.

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23
Q

What are the 2 phases of the menstrual cycle?

A

Follicular phase
Luteal phase

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24
Q

What occurs in the follicular phase?

A

The follicle starts to grow.

Oestrogen can pass into the hypothalamus, which can pass into the hypothalamus to increase GnRH pulsation.

Only one follicle usually ovulates.

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25
Q

What occurs in the luteal phase?

A

Follicle will form the corpus luteum.

26
Q

How long following the LH surge will it take until ovulation begins?

A

34-36 hours.

27
Q

Does male fertility decrease with age?

A

Yes, it is equal to the depreciation observed in female fertility.

28
Q

In which cells are testosterone produced?

A

Leydig cells

29
Q

What is produced in sertoli cells?

A

Androgen-binding globulin, that carries testosterone into the testes.

30
Q

What is primary hypogonadism?

A

A reduction in testosterone production, resulting from an issue at the testes. Will produce GnRH/LH/FSH in response (hypergonadotrophic hypogonadism).

31
Q

Is spermatogenesis, or testosterone production more affected in primary hypogonadism?

A

Spermatogenesis

32
Q

Where is affected in secondary hypogonadism?

A

Hypothalamus/Pituitary gland (the testes are capable of normal function).

33
Q

What is the most common genetic cause of primary hypogonadism?

A

Klinefelter’s syndrome

Genotype is 47XXY

34
Q

What lifestyle changes may be suggested in those with fertility issues?

A

Smoking cessation
Stop recreational drugs/methadone
Reduce alcohol intake
Moderate caffeine intake
Reduce BMI to 18.5-30

35
Q

How does obesity affect women attempting to conceive?

A

2.5x less likely to conceive
More likely to miscarry
Decreased chance of fertility treatment success

36
Q

How does obesity affect men attempting to conceive?

A

2x less likely to conceive
3x less likely to suffer erectile dysfunction

37
Q

What should all women attempting to conceive take?

A

400ug of folic acid daily (continue this through the first 12 weeks of pregnancy.

38
Q

What women should be advised to take 5mg of folic acid?

A

Previous baby with neural tube defect
Family history of neural tube defect
Diabetic mothers
Obese mothers

39
Q

How does rubella affect a developing neonate?

A

Microcephaly
Patent ductus arteriosus
Visual abnormalities

Prevent risk by giving mothers MMR booster - should be atleast 4 weeks before conception.

40
Q

How should pregnant women with chlamydia be treated?

A

100mg of doxycycline twice daily for 7 days.

Treat both partners.

41
Q

How common are anovulatory cycles?

A

Very common - around 10% of all cycles.

42
Q

How does ovarian failure present in blood tests?

A

Raised FSH and LH
Low oestrogen levels

43
Q

What are group 1 ovulatory disorders?

A

Those that affect the hypothalamus, causes include:
Excessive exercise
Anorexia
Kallmann’s syndrome
Isolated gonadotrophin deficiency

44
Q

What are group 2 ovulatory disorders?

A

Those caused by hypothalamic-pituitary axis dysfunction.

Most cases are due to PCOS or anovulation.

45
Q

How are bloods affected in group 1 ovulatory disorders?

A

Low LH
Low FSH
Low oestrogen

46
Q

What are group 3 ovulatory disorders?

A

Those with ovarian failure.

May also be due to hypothyroidism and hyperprolactinaemia.

47
Q

What medication can be used to induce ovulation in PCOS?

A

Clomifene citrate (50mg/day) - taken on days 2-6 of the cycle.

Confirm with USS that follicle has grown.

48
Q

If clomifene citrate is unsuccessful, what should be given?

A

Gonadotrophin injections

Risk of multiple pregnancies when taking this therapy.

49
Q

What is third-line in PCOS infertility management?

A

Surgery - laparoscopic ovarian diathermy.

50
Q

What is a hydrosalpinx?

A

When a fallopian tube is blocked with fluid.

May be due to a pelvic infection, or an STI.

51
Q

What form of fibroid impact fertility?

A

Submucosal fibroids

These bulge into the endometrial cavity.

52
Q

Can a vasectomy be reversible?

A

Yes - 50% success rate of unlocking vas deferens.

53
Q

What should be given to supplement an IVF pregnancy?

A

Progesterone to keep the endometrial lining thick and healthy.

54
Q

What is oligomenorrhoea?

A

A menstrual cycle lasting more than 42 days.

55
Q

What criteria is used to diagnose PCOS?

A

Rotterdam criteria

Patients require any 2 of the following:
- Oligomenorrhoea/Amenorrhoea
- Polycystic ovaries on a USS
- 12 or more follicles of <9mm
- Increased ovarian volume (>10ml)

56
Q

If not keen on clomifene citrate as an ovulation-inducer, what may be given?

A

Tamoxifen, or letrozole.

57
Q

How can it be ascertained whether ovulation has occurred or not?

A

21 day mid-luteal progesterone level

58
Q

What is premature ovarian failure?

A

Menopause occurring before the age of 40.

59
Q

What are potential causes of premature ovarian failure?

A

Turner’s syndrome
Fragile X
Autoimmune disease

60
Q

How is premature ovarian failure treated?

A

Give HRT
Consider egg conservation.

Endocrine (11 decks)

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