Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrine > Reproduction: Infertility > Flashcards

Reproduction: Infertility Flashcards

1
Q

Infertility

A

Failure to achieve a clinical pregnancy after 12 months or more of regular unprotected intercourse (in absence of known reason) in a couple who have never had a child

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Primary infertility

A

Couple never conceived

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Secondary infertility

A

couple previously conceived but pregnancy not successful (e.g. miscarriage or ectopic pregnancy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Epidemiology

A

Affects 1:6 couples (~15%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Factors Increasing chance of conception

A 
Women <30 years 
Previous pregnancy
<3 years trying to conceive 
Intercourse occurring around ovulation 
Womens BMI 18.5-30 
Caffeine intake <2 cups daily 
No use of recreational drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Infertility aetiology

A

Multiple factors (female +/- male)

Tubal factor 
Ovulatory dysfunction 
Diminished ovarian reserve
Endometriosis 
Uterine factor 
Fibroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Anovulatory Infertility

A

Ovaries do not release an oocyte during menstrual cycle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Anovulatory Infertility Aetiology

A

Physiological

  • Before puberty
  • Pregnancy
  • Lactation
  • Menopause

Gynaecological Conditions

  • Hypothalamic (anorexia/ bulimia, excessive exercise)
  • Pituitary (hypoprolactinaemia, tumours, Sheehan syndrome)
  • Ovarian (PCOS, premature ovarian syndrome)

others

  • systemic disorder
  • endocrine disorder
  • drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Polycystic Ovarian Syndrome

A

heterogeneous disorder characterised by hyperandrogegism and ovarian dysfunction which results in amenorrhoea or oligomenorrhoea and is associated with sub fertility.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PCOS prevalence

A

Commonest endocrine disorder in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PCOS aetiology

A

Inherited condition

Weight gain exacerbates condition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PCOS clinical features

A

obesity
hirsutism or acne
cycle abnormalities
Infertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

PCOS endocrine features

A

High free androgens
High LH
Impaired glucose tolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

PCOS diagnosis

A

Requires ⅔
Chronic an ovulation
Polycystic Ovaries
Hyperandrogenism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Premature Ovarian syndrome prevalence

A

1% before age 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Premature Ovarian Syndrome Aetiology

A 
Idiopathic 
Genetic 
- Turners Syndrome, Fragile X
Chemotherapy
Radiotherapy 
Oophorectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Premature Ovarian Syndrome clinical features

A

hot flushes
night sweats
atrophic vaginitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Premature ovarian syndrome endocrine features

A

High FSH
High LH
Low oestradiol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Tubal Disease Aetiology

A

Infective

  • Pelvic inflammatory disease
  • transperitoneal spread
  • procedures (IUCD insertion, hysteroscopy)

Non-infective

  • Endometriosis
  • Surgical
  • fibroids
  • Polyps
  • Congenital
  • Salpingitis Isthmica Nodosa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Tubal Disease Clinical Features

A 
Abdo/pelvic pain 
Febrile
Vaaginal Discharge
Dyspareunia
-Cervical excitation 
-Menorrhagia
-Dysmenorrhoea
-Infertility
-Ectopic Pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Endometriosis

A

Presence of endometrial glands outside uterine cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Endometriosis prevalence

A

~20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Endometriosis aetiology

A

–> Retrograde menstruation

Altered immune function
Abnormal cellular adhesion molecules
Genetic

24
Q

Endometriosis Clinical Features

A 
Dysmenorrhoea
-Dysparenuia 
-Menorrhagia 
- Painful defection 
-Chronic pelvic pain 
Uterus may be fixed and retroverted

Scan may show characteristic ‘chocolate’ cysts on ovary

25
Q

Male Infertility Pre-testicular aetiology

A

Endocrine

  • hypogonadotrophic hypogonadism
  • Hypothyroidism
  • hyperprolactinaemia
  • diabetes

Coital Disorders

  • Erectile dysfunction
  • ejaculatory failure
26
Q

Male Infertility: Testicular Aetiology

A

Genetic

  • Klinefelter syndrome
  • Y chromosome deletion
  • Immotile cilia syndrome

Congenital

  • Cryptorchidism
  • Infective
  • Antispermatogenic agents

Vascular

  • Torsion
  • Varicocele

Immunological

27
Q

male Infertility: Post testicular aetiology

A

OBSTRUCTIVE

Epididymal

  • Congenital
  • Infective
Vasal 
- Genetic: CF
-Acquired
         Vasectomy
          Ejaculatory duct obstruction 
          Accessory Gland infection 
- Immunological 
          Idiopathic 
         Post vasectomy
28
Q

Non- Obstructive male Infertility clinical features

A

Low testicular volume
Reduced secondary sexual characteristics
Vas deferens preset

29
Q

Non-obstructive male. infertility endocrine features

A

High LH and FSH

Low testosterone

30
Q

Obstructive male Infertility clinical features

A

normal testicular volume
normal secondary sexual characteristics
Vas deferent may be absent

31
Q

Obstructive male infertility endocrine features

A

Normal LH, FSH and testosterone

32
Q

Investigations of infertility

A

History
Female Exam
Male exam

33
Q

Investigation of female

A

Endocervical swab for chlamydia
Cervical smear if due
Blood for rubella immunity

Midluteal progesterone level
- progesterone >30nmol/L suggests ovulation

34
Q

Tests of tubal latency

A

Hysterosalpingiogram

  • If no known risk factors of tubal/ pelvic pathology
  • If laparoscopy contraindicated due to obesity, previous pelvic surgery, Crohn’s

Lparoscopy

  • Possible tubal /pelvic disease
  • Known previous pthology
  • History suggestive of pathology
  • Previously abnormal HSG
35
Q

Hysteroscopy Investigation of Infertility

A

Only performed in cases where known or suspected endometrial pathology
- uterine septum, adhesions, polyp

36
Q

Pelvic US Investigation of Infertility

A

Perform when abnormality on pelvic exam
- enlarged uterus. adnexal mass

When required from other investigations
- possible polyp seen at HSG

37
Q

Infertility Investigations (Female0

A

Anovulatory Cycles or Infrequent Periods

  • Urine HSG
  • Prolactin
  • TSH
  • Testosterone and SHBG
  • LH,FSH and oestradiol

Hirsute
- Testosterone and SHBG

Amenorrhoea

  • Endocrine profile
  • Chromosome analysis
38
Q

Investigation of Male Infertility

A

Semen Analysis
-Twice over 6 weeks apart

If abnormal semen analysis

  • LH and FSH
  • Testosterone
  • Prolactin
  • Thyroid function

Severely abnormal semen analysis

  • endocrine profile
  • chromosome analysis
  • screen for CF
  • Testicular biopsy

Abnormality on genitalia exam
-Scrotal US

39
Q

Management: Lifestyle Advice

A 
Stop smoking 
Reduce/ stop alcohol intake
Achieve BMI 18.5 to 30 
Stop recreational drugs 
Stop taking methadone 
Reduce caffeine intake (<2 cups daily)
40
Q

Importance of healthy weight

A

Obesity causes increase of fertility problem and miscarriage weight
Decreases success of fertility

Also important for male problem as obesity can result in erectile dysfunction and ejaculatory problems

41
Q

Management: Vitamin Supplements

A

Folic Acid

  • 400 micrograms daily before pregnancy and during first 12 weeks
  • 5 milligrams if either parent has neural tube defect, previous baby with neural tube defect or parent has diabetes

Vitamin D
- 10 micrograms of Vitamin D per day for pregnant and lactating women at increased risk of Vit D deficiency

42
Q

Routine Investigations

A 
Blood Rubella Immunity
Chlamydia 
Ovulation (progesterone test) 
Tubal Patency Test 
Semen Analysis
43
Q

Management Reproductive Surgery (2)

A

Primary surgical treatment for infertility

Surgery to enhance IVF outcome

44
Q

Primary treatment for infertility

A

Pelvic Adhesions
Grade 2 or 3 Endometriosis
- Chocolate cyst in ovary
Tubal Block

45
Q

Surgery to Enhance IVC outcome

A

Laparoscopy

Hysteroscopy

46
Q

Salpingostomy

A

Operation performed to restore free passage through a blocked Fallopian tube
Blocked portion of the tube is removed surgically and continuity is restored.

47
Q

Tubal Disease

A

Mild Tubal Disease
- Total surgery may be more effective than no treatment

Proximal Tubal Obsturction
- Selective Salpingostomy plus tubal catheterisation or hysteroscopic tubal cannulation

48
Q

Hydrosalpinx

A

Accumulation of fluid in one of the Fallopian tubes due to inflammation and subsequent obstruction
Usually a result of pelvic infection

49
Q

Hydrosalpinx Management

A

Laparoscopic Salpingectomy before IVF treatment

Laparoscopy Contraindications (ie Crohns) 
--> hysteroscopic tubal cannulation
50
Q

Intrauterine Adhesions

A

Patients with amenorrhoea and intrauterine adhesions
–> hysteroscopic adhesiolysis

Hysteroscopic adhesiolysis is likely to restore menstruation and improve chance of pregnancy

51
Q

Endometriotic Cyst

A

Minimal or mild endometriosis
- surgical ablation or resection + laparoscopic adhesiolysis

Ovarian Endometriomas
- laparoscopic cystectomy

Moderate/ Severe Endometriosis
- Surgical treatment

Measure or Polypectomy

52
Q

Polypectomy

A

Endoscopic or surgical removal of a poly

53
Q

Fibroid Management

A

Submucosal Fibroids
- Treat hysteroscopically

Intramural Fibroids
-Treatment individualised

Subserosal Fibroid
- Unlikely to have impact on fertility

Conservative treatment not routinely offered

54
Q

Male Fertility Management

A

Surgery to obstructed vas deferent

intrauterine insemination in mild disease

Intracytoplasmic sperm infection (ICSI)

Surgical Sperm aspiration from epididymis or textile combined with ICSI

Donor Sperm Insemination

55
Q

IVF Treatment (Stages-9)

A 
Pre-IVF Workup 
Ovarian Stimulation 
Monitoring 
Ovulation Induction 
Oocyte Retrieval 
Preparation of Sperms 
In Vitro Fertilisation 
Embryo Transfer
Luteal Support

Endocrine (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions