Reproduction Flashcards
What is the length of a regular menstrual cycle?
28-35 days
What s the definition of oligomenorrhoea?
cycle>35 days
What is amenorrhoea?
absent menstruation
What is the HPO axis?
Hyp: GnHR+
Pit: LH+,FSH+
Ovaries: eostradiol and progesterone
nb, negative feedback
What are the 2 phases of the menstrual cycle?
follicular (1-14)
Luteal (14-28)
What triggers ovulation?
Surge in LH (36hrs before ovulation)
When do eostradiol levels peak?
before ovulation
When do progesterone levels peak? where are the produced?
after ovulation
produced by corpus luteum
How is ovulation assessed in regular cycles?
midluteal serum progesterone (>30nmol/L) x2 samples
Day 21
How is ovulation assessed in irregular cycles?
probably anovulatory
need further hormone investigation
When is the early follicular phase and what is assessed here?
2-5 days
serum FSH, LH, eostradiol
Serum PRL, TSH
Free androgen index
What is the progesterone challenge test?
menstrual bleed in response to 5 day course progesterone
indicates normal eostrogen levels
What radiological investigations can be done to assess ovulation?
TVUS of ovaries
MRI pit fossa
DEXA scan
What other types of tests can be used to assess ovulation?
karyotyping
visual field
autoantibodies
What happens in hypothalamic pituitary failure?
Hypogonadotrophic hypogonadism low levels gonadotrophins oestrogen deficiency normal PRL Amenorrhoea
What can cause hypothalamic pituitary failure?
stress exercise anorexia brian tumours head trauma Kallman's syndrome drugs (steroids, opiates)
How do you manage hypothalamic anovulation?
Stabilise weight (BMI>19)
pulsatile GnRH if hypog hypog (administer every 90 mins, IV or SC pump worn continuously)
Gonadotrophin daily injections (FSH+LH)
US monitoring for follicle tracking
What is hypothalamic pituitary dysfunction?
Normal gonadotrophins
Normal oestragen
Anovulation (oligo/amenorrhoea)
PCOS
How is polycystic ovary syndrome diagnosed?
2+ of: oligo/amenorrhoea polycystic ovaries (USS) -12/more 2-9mm follicles -increased ovarian volume >10ml -uni/bilateral Clinical +/- biochemicalsigns hyperandrogenism (acne/hirsutism)
What is the significance of insuin resistance in PCOS?
hyperinsulinaemia as normal pancreatic reserves compensate
insulin is cogonadotrophin to LH (inc LH, alther LH:FSH)
Insulin lowers SHBG levels, inc testoterone, hyperandrogensim
What are the symptoms of PCOS?
subfertility oligo/amenorrhoea hirsutism obesity acne alopecia
How is PCOS pre treated?
weight loss (BMI
How is ovulation induced in PCOS?
*Clomifene citrate (50-100mg tab days 2-6) Gntrophin therapy (daily injections) Laparoscopic ovarian diathermy (risk destruction)
How can metformin be used to induce ovulation in PCOS?
improves insulin resistance
restores menstruation and ovulation
What happens in ovarian failure?
High gonadotrophins
Low oestragen
What can cause ovarian failure?
Premature menopause Turner's syndrome Autoimmune pelvic radiotherapy chemo
How is premature ovarian failure defined?
menopause before 40yrs
amenorrhoea
raised FSH >30 x2 samples
Low eostradiol
How can premature ovarian failure be treated?
HRT*
assisted conception
cryopreservation
How is reduced overain reserved diagnosed?
raised FSH
low Anti Mullerian Hormone (AMH)
reduced antral follicle count on USS
What are the risks of stimulating ovulation?
ovarian hyperstimulation
multiple pregnancy
Cancer
What are the complications with multiple pregnancy?
miscarriage HT/preeclampsia Gestational diabetes Low birth weight prematurity stillbirth
What is the definition of infertility?
failure to achieve pregnancy in 12 months unprotected sex with no other reason
What is the difference between primary and secondary infertility?
P:never conceived before
S: conceived before (not necessarily successful)
What decreases chance of conception?
F >35yrs No previous pregnancy More than 3 years trying intercourse incorrectly timed F BMI 30 Smoking Caffeine Alcohol
What are the female causes of infertility?
ovulation failure
endometriosis
tubal damage
How does anorexia affect fertility?
low FSH, LH and oestradiol
What can cause tubal disease?
Infective (STD, TB, transperitioneal spread, following procedure)
Noninfective (endometriosis, surgical,fibroids, polyps)
