Subfertility Flashcards

1
Q

Define sub fertility

A

“inability of couples to achieve clinical pregnancy after 12 months of regular unprotected sex”

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2
Q

Give 3 factors which may influence subfertility

A
  • Age
  • Duration of infertility (>3 years lessens chance of conception)
  • Timing of intercourse (sperm need to be there before ovulation)
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3
Q

When should a sperm sample be obtained for semen analysis?

A

2-5 days after abstinence

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4
Q

Give the 3 normal values expected in semen analysis

A
  • > 15million/ml
  • > 40% motility
  • > 4% normal sperm
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5
Q

Give 3 causes of male subfertility

A
  • Defective sperm transportation
  • Defective sperm production
  • Hypogonadotrophism
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6
Q

Give 4 techniques used to investigate male subfertility

A
  • History
  • Testicular examination
  • Semen analysis
  • Karyotype
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7
Q

Define obstructive azoospermia

A

Normal sperm production but no sperm in ejaculations (blocked epididymis or vas deferens or congenital absence of vas in CF)

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8
Q

Define non-obstructive azoospermia

A

Testicular failure (increased FSH) or small testicular volumes (biopsy, karyotype for XXY?)

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9
Q

What is hypogonadotrophic hypogonadism?

A

Failure to stimulate spermatogenesis (rare).

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10
Q

What are the 3 groups in the WHO classification of an ovulation?

A

1: Hypothalamic pituitary failure
2: Hypothalamic-pituitary-ovarian axis dysfunction
3: Ovarian failure

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11
Q

How does hypothalamic pituitary failure present and what is its treatment?

A

Amenorrhoea and Low gonadotrophin

Tx: GnRH agonist

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12
Q

What are the Rotterdam criteria in which 2 out of 3 are needed to diagnose PCOS?

A

Biochemical or clinical evidence of androgen excess (more testosterone or hirsutism)

Amenorrhoea or oligomenorrhoea

TV USS features of PCO (string of pearls appearance)

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13
Q

What is the 1st line drug treatment in PCOS?

A

Clomifene

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14
Q

What is the 2nd line drug treatment in PCOS?

A

Letrozole

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15
Q

What condition results from ovaries over responding to gonadotrophin injections causing systemic disease?

A

Ovarian hyperstimulation

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16
Q

Give 3 causes of premature ovarian failure

A

Idiopathic
AI
Turner’s syndrome (45XO)

17
Q

Give 2 causes of tubal subfertility

A

PID

Endometriosis

18
Q

Give 3 investigations for tubal subfertility

A
  • Chlamydia swab
  • TV USS
  • Laparoscopy and dye test
19
Q

Give 3 types of assisted reproductive technology

A
  • IVF
  • Intrauterine insemination
  • Donor sperm +/- donor egg
20
Q

Give 4 points of eligibility of IVF in Scotland

A
  • Co-habiting in stable relationship >2 years
  • <42 y/o
  • BMI >18.5 and <30
  • Both non-smokers