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MBBS VI: O&G > Reproductive medicine > Flashcards

Reproductive medicine Flashcards

1
Q

Define infertility

A

Infertility is defined as inability to achieve conception despite 1 year of frequent unprotected
sexual intercourse

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2
Q

Define primary infertility
Secondary infertility
Unexplained infertility

A

Primary infertility: failure to concieve in a couple who have never achieved a pregnancy
Secondary infertility: failure to concieve after 1 or more pregnancies regardless of the outcomes of those pregnancies
Unexplained infertility: infertility with all standard investigations yield normal results

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3
Q

What are the male and female general causes of infertility?

A

Male factor infertility = 30% –> poor quality or quantity of sperms
Female factor infertility =40% –> anovulation = 20%, endometriosis = 6%, tubal blockage = 14%
Sexual dysfunction = 6%
Unexplained = 30%

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4
Q

What are the 2 types of assisted reproductive technology?

A

Intrauterine insemination (IUI)
In-vitro fertilization (IVF)

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5
Q

Define oligozoospermia, azoospermia, asthenozoospermia, teratozoospermia

A

Oligozoospermia = decrease in number of sperm cells in ejaculate
Azoospermia = no sperm cells in ejaculate
Asthenozoospermia = decrease in sperm motility
Teratozoospermia = abnormal sperm morphology

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6
Q

What is the pathophysio of sperm production in males?

A

Leydig cells: LH stimulates leydig cells to produce testosterone. Testosterone is an absolute requirement for spermatogenesis.
Sertoli cells: FSH stimulates sertoli cells for growth of seminiferous tubules. Spermatogenous occurs in Sertoli cells within the seminiferous tubules. Transport of sperms to epididymis for further sperm maturation

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7
Q

What are the conditiions in females that cause anovulation?

A

Defective follicular phase = defects in follicular development resulting in hypoestrogenemia
Defective luteal phase = normal follicular phase but defective luteal phase leading to decreased progesterone but normal or increased level of estrogen: chronic anovulation will result in hyperestrogenemia which may promote endometrial hyerplasia (hence in anovulatory dysfunctional uterine bleeding –> give OCP to induce endometrial shedding)

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8
Q

What are the hypothalamic pituitary disorders in males that cause infertility?
VINDICATE

A

Account for 1-2% of cases

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9
Q

What are the spermatogenesis disorders in males that cause infertility?
+ VINDICATE

A
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10
Q

What are the sperm transport disorders in males that cause infertility?

A
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11
Q

What are the HPO axis disorders in females that cause infertility?

A
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12
Q

What are the fallopian tube disorders in females that cause infertility?

A
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13
Q

What are the endometrium, cervix and other disorders in females that cause infertility?

A
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14
Q

What is the history taking for assessing infertility?

A
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15
Q

What is done for PE in males and females for infertility?

A
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16
Q

What are the biochemical tests for males in infertility?

A
17
Q

What are the four 1st line biochemical tests for females in infertility?
What are the other Ix done not in the initial Ix?

A

Initial Ix
* CBC with DC
* Rubella status
* Endocervical swab for chlamydia screening
* Mid luteal progesterone level: test obtained on day 21 in a typical 28 day cycle. Serum progesterone level >3ng/mL is evident of recent ovulation. Low progestewrone level in mid luteal phase suggests anovulation

Other Ix not done as initial Ix
* TFT: for patients with either irregular cycles or symptoms of thyroid diseases
* Serum prolactin level: only indicated in patients with either irregular cycles or galactorrhea
* Serum testosterone level: if suspected PCOS/clinical hyperandrogenism
* Serum LH and FSH level: increased LH and FSH indicates prmary hypogonadism
* LH detection level
* Post coital test
* Anti-sperm antibodies
* Endometrial biopsy: evaluate the luteal phase (patient with chronic anovulatory cycles and abnormal vaginal bleeding may require endometrial sampling to exclude endometrial hyperplasia)

18
Q

How to make dx of unexplained subfertility?

A
18
Q

What are the imagings done for infertility?

A
  • Hysterosalpingogram (HSG): 1st line test for evaluation of tubal patency in low risk patients. Assessment of tubal occlusion (fallopain tube patency) and uterine cavity. Not useful in detecting peritubal pelvic adhesions or endometriosis
  • Diagnostic laparoscopy + chromotubation/hysteroscopy: method of choice for evaluation of tubal patency
  • Pelvic USG: suspicious of PCOS. For patients with irregular cycles then pelvic USG will be performed together with serum prolactin, TFT and serum FSH level
  • Hysteroscopy: assessment of uterine cavity (when suspected endometrial pathology, intrauterine adhesion or uterine anomalies)
18
Q

What is the general advise for males and females for infertility issues?

A
18
Q

What is the treatment of male and female infertility?

A
18
Q

What is the medical and surgical induction of ovulation?

A
18
Q

How to assess ovulation?

A
19
Q

What is the Mx algorithm for unexplained subfertility?

A
19
Q

What are the complications of ovulation induction?

A
  • Multiple pregnancy
  • Ovarian hyperstimulation syndrome
20
Q

What is intrauterine insemination (IUI)?
What are its indications?

A
21
Q

What is the timing of insemination in intrauterine insemination?
What are its complications?

A
22
Q

What are the 4 stages of assisted reproductive technology?

A

o Controlled ovarian hyperstimulation
o Oocyte retrieval under transvaginal USG guidance + Sperm retrieval
o Fertilization in-vitro with sperms ± Intracytoplasmic sperm injection (ICSI)
o Embryo selection and transfer into uterus

Stop normal menstrual cycle (with drugs)
Hormone treatments to promote super ovulation
Extract multiple eggs from the ovaries
Sperm collected, then prepared (via capacitation) and injected into egg
Fertilisation occurs externally under controlled conditions (in vitro)
Implantation of multiple embryos into uteri’s
Test for pregnancy after 2 weeks

SHE’S FIT

23
Q

What are the indications for IVF?

A
24
Q

What is the patient selection criteria for IVF?

A
25
Q

What are the prerequisit Ix before IVF?

A
26
Q

What is the procedures involved in IVF?

A
27
Q

What is the limit of tries for IVF treatment in HA?

A
28
Q

What are the complications of IVF?

A
  • Multiple pregnancy (20 – 30%)
  • Ovarian hyperstimulation syndrome (1%)
  • Ectopic pregnancy
  • Risks of oocytes retrieval: Infection/ Bleeding/ Visceral injury to vessels and bowels
29
Q

What is the general features of ovarian hyperstimulation syndrome?
What is the pathogenesis?

A
30
Q

What is the clinical manifestation of ovarian hyperstimulation syndrome (OHSS)?

A
31
Q

What is conservative and surgical mx for ovarian hyperstimulation syndrome?

A

MBBS VI: O&G (109 decks)

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