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HUMAN DEVELOPMENT 2 > Subfertility > Flashcards

Subfertility Flashcards

1
Q

Define infertility

A

a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse

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2
Q

Define primary infertility

A

When a woman is unable to ever bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth she would be classified as having primary infertility. Includes miscarriages, ectopics, abortions and stillborns.

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3
Q

Define secondary infertility

A

When a woman is unable to bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth following either a previous pregnancy or a previous ability to carry a pregnancy to a live birth

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4
Q

What are the causes of subfertility in females?

A

Ovulatory disorders, tubal damage, uterine disorders, unexplained

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5
Q

What are the three main types of ovulatory disorders?

A

Hypopituitary failure
Hypopituitary dysfunction
Ovarian failure

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6
Q

What causes hypopituitary failure?

A

Anorexia nervosa, preventing ovulation

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7
Q

What may cause hypopituitary dysfunction?

A

Polycystic ovary syndrome or hyperprolactinaemia

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8
Q

What is polycystic ovary syndrome?

A

Where a woman has 10 or more follicles on each ovary found on ultrasound

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9
Q

What will blood tests for polycystic ovary syndrome show?

A

Elevated LH, normal FSH and raised testosterone

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10
Q

What are the signs and symptoms of polycystic ovary syndrome?

A

Hyperandrogenaemia (male-pattern hair loss, acne, infertility), oligomenorrhoea, central obesity, acanthuses nigerians

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11
Q

Why does polycystic ovary syndrome put a woman at greater risk of developing diabetes?

A

There are associated metabolic abnormalities with PCOS such as abnormal serum lipid concentrations and insulin resistance which convey a greater risk

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12
Q

What is pelvic inflammatory disease?

A

An infection of the upper female reproductive tract (uterus, fallopian tubes and ovaries) caused by bacteria that spread from the vagina and cervix

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13
Q

How may pelvic inflammatory disease present?

A

May be asymptomatic, otherwise may be purulent vaginal discharge, pelvic pain, fever, pain with sex or irregular menstruation

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14
Q

How is pelvic inflammatory disease treated?

A

Antibiotics

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15
Q

Which bacteria are most likely to cause pelvic inflammatory disease?

A

Infections by Neisseria gonorrhoeae or Chlamydia trachomatis are present in 75 to 90 percent of cases

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16
Q

Which disorders may cause tubal damage that affects fertility?

A

Pelvic inflammatory disease, endometriosis, previous tubal surgery, fibroids and cervical mucus defect

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17
Q

What is endometriosis?

A

Where tissue that is histologically similar to the endometrium is found outside the uterine cavity and myometrium, most commonly in the pelvis

18
Q

What can protect against endometriosis?

A

Pregnancy and COCP

19
Q

What are the symptoms/signs of endometriosis?

A

Pain, dysmenorrhoea, menorrhagia or difficulty urinating

20
Q

What would be found on examination in endometriosis?

A

Pelvic tenderness/mass and a fixed uterus

21
Q

How is endometriosis treated?

A

NSAIDs, COCP, danazol or GnRH agonists

22
Q

What are fibroids?

A

Uterine leiomyomas, they are benign tumours of the smooth muscle of the myometrium

23
Q

How are fibroids treated?

A

Tran acid, COCP, LARCs and surgery

24
Q

What are the signs of fibroids?

A

Heavy, regular periods

25
Q

What are the male causes of subfertility?

A

Testicular (infection, undescended, trauma), azoospermia, reversal of vasectomy, ejaculatory dysfunction (retrograde or premature) or hypogonadism

26
Q

Which drugs may lead to sub fertility in women?

A

Long term NSAIDs, chemotherapy, neuroleptics, spironolactone, depo-provera

27
Q

Which drugs may lead to sub fertility in men?

A

Sulfasalazine, anabolic steroids, chemotherapy

28
Q

What hormones do the ovaries produce?

A

Oestrogen (oestrodiol), progesterone, activin and inhibit

29
Q

What tests may be conducted to assess female tubal function?

A

HSG and HyCoSy

30
Q

How may infertility due to hypopituitary failure be treated?

A

Increase weight and consider pulsatile GnRH or Gn with LH to induce ovulation

31
Q

How may subfertility due to polycystic ovary syndrome be treated?

A

Consider clomiphene and/or metformin

32
Q

How may infertility due to hyperprolactinaemia be treated?

A

Consider bromocriptine

33
Q

What is ovarian hyper stimulation syndrome?

A

Condition that occurs due to drug used to stimulate ovarian function (gonadotrophin or clomifene) and it can cause lower abdominal pain, distention, ascites, pleural effusion or venous thrombosis

34
Q

How may infertility due to ovarian failure be treated?

A

Consider donor eggs or adoption

35
Q

When is IVF offered to couples?

A

After 2 years of trying with no success

36
Q

What is intrauterine insemination (IUI)?

A

A sample of sperm is separated the lab and slower sperm is removed and best sperm are selected. These are then inserted via vaginal speculum and a small catheter into the womb. This is done at the time of ovulation (usually day 12-16 of a woman’s menstrual cycle)

37
Q

Who may require intrauterine insemination for conception?

A

Those unable to have vaginal intercourse, sperm-wash for HIV positive men or same-sex relationships (with donor)

38
Q

What is IVF?

A

Where there is fertilisation of an egg in a dish which is then grown and implanted when it is an embryo into the womb

39
Q

Outline the process of IVF.

A

> Suppress natural hormone cycle
Boost egg supply with gonadotrophins to increase the number of eggs produced
34-38 hours before eggs are due to collection, hormone injection to aid maturation
Collection of eggs with USS guidance
Eggs fertilised with prepared sperm
Incubated for 6 days and best quality are chosen for implantation (one or two)

40
Q

Who is IVF offered to?

A

o Women under 40 who have not conceived after 2 years of unprotected intercourse or 12 cycles of artificial insemination (6 IUI).

41
Q

What is intracytoplasmic sperm injection (ICSI)?

A

Single spear is selected to be injected directly into an egg

42
Q

Who may have intracytoplasmic sperm injection (ICSI)?

A

If there are severe defects in sperm quality, azoospermia or IVF treatment failed

HUMAN DEVELOPMENT 2 (23 decks)

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