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HD 2 > Subfertility > Flashcards

Subfertility Flashcards

1
Q

What is the difference between primary and secondary infertility

A 
Primary= unable to ever get pregnant/ carry a baby
Secondary= unable to get pregnant/ carry a baby having already had at least once succesful pregnancy
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2
Q

What are the main causes of subfertility and in what proportion

A 
Ovulatory disorders: 25%
Tubal damage: 20%
Uterine/ peritoneal disorders: 10%
Male factors 30%
Unexplained 25%
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3
Q

In what % of cases are both male and female factors found

A

40

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4
Q

What hormone surges at ovulation

A

LH

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5
Q

What dosage of folic acid is given during pregnancy

A

400mg

500mg if on any enzyme inducers

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6
Q

What is an example of hypopituitary failure

A

Anorexia Nervosa

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7
Q

What is an example of hypopituitary dysfunction

A

PCOS, hyperprolactinaemia

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8
Q

What is type 3 ovarian failure

A

Premature ovarian failure if under 40

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9
Q

What is the diagnosis criteria for PCOS

A
  • Clinical hyperandrogenaemia
  • Oligomenorrhoea
  • Polycystic ovaries on ultrasound
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10
Q

What will blood tests show on somebody with PCOS

A

Raised LH
Normal FSH
Raised testosterone

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11
Q

What metabolic disease is often linked to PCOS

A

Diabetes Mellitus

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12
Q

Name 5 tubal and uterine causes of infertility

A
  • Pelvic inflammatory diseases
  • Previous tubal surgery (including surgery for ectopic pregnancy)
  • Endometriosis
  • Fibroids
  • Cervical mucus defect
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13
Q

How often does infertility occur after pelvic inflammatory disease

A

10% after 1 episode

50% after 3 episodes

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14
Q

Acute symptoms of pelvic inflammatory diseases

A 
Pelvic pain
deep dyspareunia
Malaise
Fever
Purulent vaginal discharge
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15
Q

What histological changes can be seen in endometriosis

A

Presence of tissue similar to endometrium outside the uterine cavity- most commonly in the pelvis

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16
Q

What increased the risk of endometriosis

A

Age
FH
Frequent cycles

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17
Q

Symptoms of endometriosis

A

Pain
Dysmenorrhoea
menorrhagia
dyspareunia

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18
Q

Symptoms of fibroid

A

Heavy regular periods

19
Q

What are fibroids

A

Benign tumours of smooth muscle of the myometrium

20
Q

Main causes of male infertility (5)

A
  • Testicular (infection, cancer etc)
  • Azoospermia
  • Reversal of vasectomy
  • Premature/ retrograde ejaculation
  • Hypogonadism
21
Q

What legal drugs are linked to infertility in women

A 
NSAID
Chemotherapy
Neuroleptics
Spironolactone
Depo-provera
22
Q

What legal drugs are linked to infertility in men

A

Sulfasalazine
Anabolic steroids
Chemo

23
Q

What % of couples are pregnant within the year

What % of couples are within 2

A

50

80

24
Q

How is ovulatory function assessed

A

Blood

Ovarian reserve testing- how would they respond to Gn stimulation in IVF

25
Q

How is tubal function assessed

A

HSG

HyCoSy

26
Q

How is uterine function assessed

A

Laparoscopy

27
Q

How should you treat/ manage type 1 hypopituitary failure

A

Increase weight

Consider pulsatile GnRH or Gn with LH activity to induce ovulation

28
Q

What is first line treatment of PCOS

A

Clomiphene for 6/12 max or metformin

29
Q

Second line treatment for PCOS

A

Clomiphene and metformin

Laparoscopic ovarian drilling and Gn therapy

30
Q

After how many years should IVF be offered

A

2 years

31
Q

What is an intrauterine insemination

A

Sperm is separated in lab, removal of slower speed sperm before partner in inseminated

32
Q

Who should intrauterine insemination be offered to

A

People who are unable to vaginal intercourse
Requiring specific consideration (eg sperm wash for HIV)
Same sex relationship

33
Q

How many cycles of IUI should there be before offering IVF

A

12

34
Q

Which day does insemination take place in IUI? How is insemination achieved

A

12-16

Vaginal speculum and small catheter

35
Q

What is IVF

A

Fertilisation of egg outside the body

36
Q

Who should IVF be offered toq

A

Woman under 40 who have not conceived after 2 years or 12 cycles of IUI

37
Q

How many cycles of IVF should be offered

A

3

38
Q

When can a cycle of IVF be offered to a woman aged 40-42

A
  • 2 years unprotected intercourse
  • 12 cycles AI
  • No previous IVF
  • No evidence of low ovarian reserve
39
Q

What are the 6 stages of IVF

A

1) Suppressing month cycle via injections/ nasal spray for 2 weeks
2) Boosting egg supply via injection of gonadortrophins for 12 days
3) Checking on progress through vaginal ultrasound scans and blood tests. 34-38 hours before egg collection given hormone injection for egg maturation
4) Collection of eggs using ultrasound guidance
5) Fertilising the eggs and cultivated for 16-20 hours
6- Embryo transfer

40
Q

What is ovarian hyperstimulation syndrome

A

Consequence of drugs used to stimulate ovarian function (gonadotrophin or clomifene)

41
Q

Mild ovarian hyperstimulation syndrome symptoms

A

Lower abo discomfort/ distention

Nausea

42
Q

Severe ovarian hyperstimulation syndrome symptoms

A

Abdo pain/ distention
Ascites
Pleural effusion
VT

43
Q

What is intracytoplasmic sperm injection (ICSI)

A

Embryologist selects a single sperm to be injected directly into an egg

44
Q

When is ICSI indicated

A
  • Severe deficits in semen quality
  • Azoospermia (obstructive or non obstructive)
  • Couples in whom IVF failed

HD 2 (26 decks)

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