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Y4 - GOSH > reproductive medicine > Flashcards

reproductive medicine Flashcards

1
Q

what are the 3 main factors which influence fertility

A

healthy sperm
healthy fallopian tube
healthy menstrual cycle - ovulation + endometrium

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2
Q

how common is sub-fertility?

A

1 in 6 women

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3
Q

what are the different causes of infertility

A 
anovulatory infertility - 30% 
malefactor - 35% 
tubal disease - 25% 
endometriosis - 5% 
unexplained 15%
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4
Q

what are some pre-conception advise for women who want to get pregnant

A

stop smoking
no alcohol intake
BMI < 19 and > 30 can impact the fertility
age

occupational hazards
recreational drugs

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5
Q

what are some pre-conception advise for men who want to get pregnant

A 
stop smoking 
BMI > 30 will impact fertility 
3-4 units of alcohol per week 
loose-fitting underwear 
inc scrotal temp - dec fertility

occupational hazards
recreational drugs

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6
Q

what vitamin should be given pre-conceptions?

A

folic acid - 0.4mg/day
- 5mg/day

vitamin D - 10mcg/day

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7
Q

in what situation will you give 5mg of folic acid per day?

A

if previous children/personal/FH of neural tube defect

if DM T1/2

If BMI > 30

coeliac disease

if carrier/suffer of haemoglobinopathies eg thalassemia tract

antifolate drugs

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8
Q

when will you consider a referral to reproductive medicine

A

when the couple has been trying for at least 1 year with sexual intercourse every 2-3 days or other reasons eg

- female age > 35 
know fertility problem 
- anovulatory cycles 
- severe endometriosis 
- previous PID 
- malignancy
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9
Q

what are some anovulatory disease that can cause infertility

A

Brain

  • hypothalamic hypogondaism (due to anorexia, stress, exercise)
  • hyperprolactinaemia (pituitary damage or tumour)

thyroid
- hypo/hyperthyroidism

adrenal hyperplasia

ovaries
- PCOS, premature ovarian insufficiency

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10
Q

what can be an indication of prolactinoma

A

visual field defect

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11
Q

what are some of the management of subfertility

A

1 - clomifene - encourage ovulation
2 - gonodatrophin - used when FSH is normal and clomifene resistance PCOS
3 - laproscopic ovarian diathermy - destroy part of the ovary to release an egg
4 - insulin sensitizer - used in PCOS/weight loss more effectie
5 - surgery - treat any adhesion, tubal damage, assisted pregnancy

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12
Q

what is the WHO classification of anovulatory infertility

A

3 different groups

Group 1 - hypothalamic pituitary failure - brain
Group 2 - hypothalamic-pituitary-ovarian dysfunction (PCOS)
Group 3 - ovarian failure (premature ovarian insufficiency)

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13
Q

what is a primary ovarian failure

A

the patient was never able to conceive ever

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14
Q

what is a secondary ovarian failure

A

the patient previously conceived but not able anymore

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15
Q

what are some causes to primary ovarian failure

A 
premature ovarian failure 
genetic 
turner's syndrome 
autoimmune 
iatrogenic - surgery/chemo
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16
Q

what are some causes to secondary ovarian failure

A

PCOS
excessive weight loss or exercise
hypopituitarism - tumour, surgery, trauma
hyperprolactinaemia

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17
Q

what is the effect of prolactin in the body

A

acts on the breast for lactation

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18
Q

what is the effect of prolactin in the hypothalamus

A

prolactin causes -ve feedback on the thalamus

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19
Q

what are the diagnostic criteria of premature ovarian failure

A

oligo/amenorrhoea for >4 m

elevated FSH > 25 IU/L > 4 wks apart

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20
Q

what is the mean menopausal age in the UK?

A

51

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21
Q

what age is considered to be pre-term menopause

A

<40

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22
Q

what age is considered to be premature menopause

A

40-45

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23
Q

how common is POI

A

1% of women < 40

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24
Q

what is the classical hormonal pictures of POI

A

oestrogen and inhibin are both low

FSH is elevated

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25
Q

what is the main P/C of POI?

A

amenorrhoea/oligomenorrhoea
difficulty conceiving
menopausal symptoms

26
Q

what are the managements of POI?

A

as there are only a few ovum left and so oocyte donation is the only viable way to get pregnancy

not other proven ways to increase the responsiveness of the oocytes

27
Q

what is nidation

A

it is the process which the cilia is wafting the ovum/embryo down to the endometrium

28
Q

what are some causes to tubal damages?

A

infection - chlamydia
endometriosis
surgery - adhesion

29
Q

what are some examples of surgical damages that can cause tubal damages?

A

TOP - adhesion and retention of the conception material

30
Q

what can be done to improve the chance of pregnancy in women who have endometriosis

A

surgery to remove extra-endometrial material

31
Q

what are some investigations that can be done to check for tubal patency

A

hysterosalpingogram - radioactive dye injected into the endometrium and X-ray taken to see patency

Hysterosalpingo-contrast-ultrasonography - alternative to HSG and no radiation since USS

laparoscopy with dye - gold standard, can diagnose pathology and treatment

32
Q

what are the risk/SE of HSG and Hysterosalpingo-contrast-ultrasonography

A

can be uncomfortable
can cause spasm of the fallopian tube - false +ve
but general good specificity and sensitivity

33
Q

what is the risk of laparoscopy with dye in detecting tubal defect

A

general anaesthesia risks and surgical risks

34
Q

what are included in the semen analysis

A 
volume 
total sperm count 
concentration of sperm 
vitality 
progressive motility 
total motility 
normal morphology
35
Q

what are some causes to male factor infertility

A 
idiopathic (most common) 
genetic 
hypogonadism 
testies trauma/surgery/developmental abnor
obstructive 
anabolic induced 
previous chemo/radio
36
Q

what is the treatment for male factor infertility if sperm present in the ejaculation

A

ICSI

37
Q

what is the treatment for male factor infertility if sperm absent in the ejaculation

A

sperm donor or surgical retrieval of sperm

38
Q

what is ART

A

assisted reproductive technolgies

39
Q

what does ART include

A

any fertility treatments in which sperm and oocytes are handled with the aim for pregnancy

IVF, ICSI, IUI, PGD, egg donation and surrogacy

40
Q

what does IUI stand for?

A

Intra-uterine injection

41
Q

what does IVF stand for?

A

in-vitro fertilisation

42
Q

what does ICSI stand for?

A

Intra-cytoplasmic sperm injection

43
Q

what does PGD stand for?

A

pre-implantation genetic diagnosis

44
Q

what is the best mode of ART for male factor infertility

A

ICSI

45
Q

what is the best mode of ART for tubal damage

A

IVF

46
Q

what are the indications of IVF

A 
tubal damage 
endometriosis 
anovulation 
male factor subfertility 
reduced fertility with inc maternal age
47
Q

what are depending factors of successful IVF

A 
duration of subfertility 
age 
elevated FSH
previous pregnancy 
previous failed IVF 
presence of hydrosalpinx and intramural fibroids
smoking and inc BMI
48
Q

what is the procedure of IVF

A

1) FSH given to stimulate he releases of eggss
2) HCG given to help mature egss
3) needle guide aspiration
4) sperm collected and place in the same ditch as eggs for fertilisation - Day 0
5) Day 1 - check to see if fertilisation has taken place or not
6) leave to mature further until Day 5
7) selected embryo is re-inserted back into the endometrium + luteal support by progesterone
8) pregnancy test 2 weeks after

49
Q

how many embryos are given in a single circle of IVF

A

max 2

50
Q

what do you do with the already fertilised embryo

A

can freeze them for later

51
Q

what is the difference between IVF and ICSI

A

IVF simply place the sperms near egss

ICSI insert sperms directly into eggs

52
Q

what single test should be performed before ICSI being carried out?

A

karyotype for CF

53
Q

what is IUI

A

intra-uterine insemination - placing sperms inside the womb of women

54
Q

when is IUI considered

A

usually lesbian couple

55
Q

what are some side effect of ART

A

egg collection - intra-peritoneal haemorrhage and pelvic infection

pregnancy complications - inc multiple pregnancies, rate of ectopic pregnancy are also higher

genetic - chromosomal and gene abnor associated with inc risk in ICSI

mental wellbeing

superovulation - multiple pregnancies and ovarian hyper-stimulation

56
Q

what is ovarian hyperstimulation syndrome

A

complications of ovulation induction or superovulation leading to vEGF over-expression

57
Q

what are some of the symptoms of ovarian hyperstimulation syndrome

A 
abdo pain 
bloating 
N+V
inc ovarian sizes 
ascites
58
Q

what is the classical picture of OHSS

A

inc ovarian size

fluid shift from intra to extracellular compartment to abdo and pleural spaces

intravascular fluid depletion - hypercoagulopathy, haemoconcentration

59
Q

RF for OHSS

A

PCOS
low BMI
previous OHSS

60
Q

management of OHSS

A

symptomatic relief
prevention of haemoconcentration and thromboembolism
maintenance of cardiorespiratory function

paracentesis for ascite
consider heparin for thrombophylaxis

Y4 - GOSH (12 decks)

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