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HD CC > Subfertility > Flashcards

Subfertility Flashcards

1
Q

Infertility

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

Primary infertility

A

Woman unable to ever bear a child, either due to inability to become pregnant or inability to carry a pregnancy to a live birth
–> miscarriages, ectopics, abortions and stillborns

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3
Q

Secondary infertility

A

Woman unable to bear a child, either due to inability to become pregnant or inability to carry a pregnancy to 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

Subfertility Causes

A 
Ovulatory Disorders (25%)
Tubal Damage (20%)
Uterine/peritoneal disorders (10%)
Male factors (30%)
Unexplained (25%)
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5
Q

Ovulatory causes

A

Type 1- Hypopituitary failure (anorexia)
Type 2- Hypopituitary Dysfunction e.g. PCOS, hyperprolactinaemia
Type 3- Ovarian Failure

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6
Q

PCOS

A

2 out of3 of:
Clinical hyperandrogenaemia
Oligomenorrhea (less than 6-9 periods/year)
Polycystic ovaries on ultrasound

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7
Q

PCOS signs

A 
Menstrual disturbance (oligomenorrhea, amenorrhea, DUB)
Infertility hirsutism
Acne
Male pattern hair loss
Central obesity
Acanthosis nigricans
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8
Q

PCOS medical signs

A

Raised LH with normal FSH

Raised testosterone

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9
Q

PCOS exclusions

A

Thyroid dysfunction
Congenital adrenal hyperplasia
Hyperprolactinaemia
Androgen-secreting tumours

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10
Q

PCOS associated metabolic abnormalities

A

Abnormal serum lipid concentrations

Insulin resistance

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11
Q

Tubal + Uterine causes of Infertility

A 
Pelvic inflammatory disease
Previous tubal surgery
Endometriosis (uterine + tubal)
Fibroids (uterine)
Cervical mucus defect
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12
Q

Pelvic Inflammatory disease- Acute

A 
May be asymptomatic
Pelvic pain
Deep dyspareunia
Malaise
Fever
Purulent vaginal discharge
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13
Q

PID Examination

A

Cervical excitation
Adnexal tenderness
Discharge
pyrexia

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14
Q

PID Investigation

A

ECS- MC+S plus chlamydia, FBC, raised ESR

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15
Q

PID Management

A

Antibiotics
Rest
Abstinence

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16
Q

Chronic PID

A

From inadequately treated acute PID

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17
Q

Endometriosis

A

Presence of tissue histologically similar to endometrium outside uterine cavity + myometrium
Most commonly found in pelvis

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18
Q

Endometriosis RFs

A

Age
FH
Frequent cycles

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19
Q

Endometriosis symptoms

A

Pain
Dysmenorrhoea
Menorrhagia
Dyspareunia

20
Q

Endometriosis exam

A

Pelvic tenderness or mass

Fixed uterus

21
Q

Endometriosis management

A 
NSAIDs
Norethisterone
Danazol
GnRH agonists
Surgery
22
Q

Fibroids

A

Uterine leiomyoma

Benign tumours of smooth muscle of myometrium

23
Q

Fibroids types

A

Subserosal
Intramural
Pedunculated
Submucosal

24
Q

Fibroids symptoms

A

Heavy, regular periods

25
Q

Fibroids management

A

Tran acid
COCP/LARCs
Surgical

26
Q

Male causes infertility

A 
Testicular- infection, cancer, surgical, congenital, undescended testes, trauma
Azoospermia
Reversal vasectomy
Ejaculatory problems
Hypogonadism
27
Q

Drugs linked to infertility- WOMEN

A 
Long term NSAID use
Chemotherapy
Neuroleptics
Spironolactone
Depo-provera
28
Q

Drugs linked to infertility- MEN

A

Sulfasalazine
Anabolic steroids
Chemotherapy
Chinese herbs for improving sperm count + motility

29
Q

Drugs linked to infertility- BOTH

A

Marijuana
Coke
Other illicit drugs

30
Q

Investigations by GP prior to infertility referral

A 
Full sexual/contraception/fertility history
PCOS screen- day 21 progesterone, LH, FSH, serum testosterone, glucose
FBC
TSH
Vit D
HbA1c
HIV
Hep
Rubella
STI screen
31
Q

Sperm count ranges

A

Volume (ml) LRL 1.5ml
Progressive motility (%) LRL 32%
Morphology (%) LRL 4% normal

32
Q

Assessing tubal function

A

HSG

HyCoSy

33
Q

Assess uterine function

A

Laparoscopy

34
Q

Ovulatory disorder- Type 1 hypopituitary failure Management

A

Increase weight
Decreases exercise
Pulsatile GnRH

35
Q

Ovulatory disorder- Type 2 PCOS Management

A

Wight loss to BMI 30 or below
Clomiphene or Metformin
Laparoscopic ovarian drilling
Gn therapy

36
Q

Ovulatory disorder- Type 2 Hyperprolactinaemia Management

A

Bromocriptine

37
Q

Ovulatory disorder- Type 3 Ovarian Failure management

A

Donor eggs

38
Q

Tubal/uterine infertility Management

A

Laparoscopic tubal surgery
Surgery prior to IVF to attempt fibroid/endometriosis clearance
Adhesiolysis
Endo treatment

39
Q

Male infertility treatment

A

Treat infections
Hypogonadism- consider gonadotrophins
Erectile dysfunction- DM control, depression support

40
Q

Clomiphene

A

Medication used to treat infertility in women who do not ovulate
Includes those with PCOS

41
Q

Intrauterine insemination (IUI)

A

Sperm is separated in lab Slower sperm removed
Partner inseminated
–> those who can’t have vaginal intercourse
15.8% success under 35

42
Q

IVF

A

Fertilisation of egg outside body

32.2% live births under 35

43
Q

IVF better if

A 
Age
Less cycles
Previous pregnancies
BMI 19-30
No smoking
No caffeine
44
Q

Ovarian hyperstimulation syndrome

A

Consequence of drugs used to stimulate ovarian function
Gonadotrophin or clomiphene
REFER

45
Q

Intracytoplasmic Sperm Injection

A

Embryologist selects single sperm to be injected directly into egg
–> severe deficits in semen quality, obstructive + non-obstructive azoospermia

46
Q

IVF risks

A

Small increased risk of borderline ovarian tumours

47
Q

Cancer + preserving fertility

A

Cryopreservation before chemo

HD CC (22 decks)

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