RPL, infertility Flashcards
Fetal demise
Fetus with cessation of cardiac activity after 10 wga
Early pregnancy loss
Non-viable IUP prior to 13 wga
Criteria for pregnancy loss
- CRL >7 mm with no heart beat
- Mean sac diameter > 25 mm and no embryo
- Absence of embryo with heartbeat > 2 wks after gestational sac without yolk sac
- Absence of embryo with heartbeat > 11 days after gestational sac with yolk sac
Antibiotic ppx for MVA
Docycycline 200 mg x 1 dose
Prevalence of miscarriage
12-15% of pregnancy
Most common etiology of RPL
Unexplained, chromosomal abnormality (90% of these aneuploidy or polyploidy)
Anatomic abnormalities that can lead to RPL
Congenital uterine anomalies, fibroids, endometrial polyps, intrauterine adhesions
Most common uterine anomaly that leads to miscarriage
Septate uterus
What to do next if you diagnose a unicornuate uterus
Urologic evaluation
Best-linked infectious causes for RPL and treatment
Ureaplasma and mycoplasma; 2 weeks of azithro, erythro, or doxy
Can empiric progesterone or ASA treat RPL of unknown cause?
Nope
Testing recommended for RPL
Karyotype POC and both partners, TVUS, HSG / sonohyterography, APS, TSH
Monthly pregnancy rate for average, normal couple
25% (20% live birth)
Most common causes of infertility
Male (35%), tubal and pelvic (35%), ovulatory (15%), unexplained (10%), other (5%)
What to do if HSG shows hydrosalpinx
Doxy 100 mg BID x 5 days
Normal semen analysis
Volume 1 mL or more
Concentration 15 mill/mL or more
Motility 40% or better
Morphology at least 4% normal
Length of spermatogenesis
3 months
Mechanism of letrozole
Aromatase inhibitor, inhibits estrogen production which decreases negative feedback to hypothalamus and pituitary
Mechanism of clomiphene citrate
SERM, blocks estrogen at hypothalamus and pituitary to decrease negative feedback
Risk of multiples with ovulation induction
~10% (<0.5% are triplets)
Side effects of ovulation induction
Headache, hot flashes, mood changes, rare visual changes (all due to anti-estrogen)
Mechanism of gonadotropins in ovulation induction
Recombinant FSH is given to induce ovulation directly
Abdominal distension, pain, nausea, SOB, hemoconcentration, renal failure, DVT related to IVF
Ovarian hyperstimulation syndrome
Treatment for ovarian hyperstimulation syndrome
Supportive: fluids, DVT ppx
Prevent: leuprolide trigger
Standard tests for infertility evaluation
HSG, US, sonohysterogram, mid-luteal progesterone, semen analysis, TSH, prolactin, day 3 FSH + estradiol, AFC, AMH
