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CP2 OBGYN > Subfertility > Flashcards

Subfertility Flashcards

1
Q

In PCOS, because there are more thecal cells, what is produced more or?

A

Testosterone

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2
Q

In PCOS, because there are more granulosa cells, what is there produced more of?

A

Oestrogen

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3
Q

Causes of PCOS (2)

A

Genetics; PCOS, T2DM, male baldness

Insulin resistance

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4
Q

PS PCOS (5)

A 
Oligomenorrhoea 
Hirsuitism 
Subfertility 
Hx glucose intolerance 
Acne, seborrhoea
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5
Q

What is the Rotterdam criteria for PCOS

A

2/3 of

1) Irreg menstrual cycle
2) Clinical or biochem evidence of androgenemia
3) Polycystic ovaries on USS

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6
Q

What ist he Ferriman Gallwey score

A

Score to determine body hair increase + distribution in PCOS

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7
Q

Which 2 cancers are you at increased risk of getting in PCOS?

A

breast

Endometrial

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8
Q

Ix PCOS

A

USS (TV)

Bloods incl LH:FSH Androgens incl testosterone, HbA1C

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9
Q

Mx PCOS

A 
W loss via lifestyle 
Coil/COCP/POP
Metformin 
Clomifene 
Surgery
IVF
Spironolactone (acne + body hair)
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10
Q

What surgery can be used for PCOS Mx

A

Ovarian drilling

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11
Q

How long does ovarian drilling last

A

2 years

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12
Q

Def infertility

A

Inability of a heterosexual couple trying to achieve pregnancy after having regular sex for >12 months

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13
Q

Def regular sex

A

2-3 times/week

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14
Q

1’ infertility

A

Female partner has never conceived

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15
Q

2’ infertility

A

Female has previously conceived

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16
Q

Contributors to subfertility (6)

A 
Ovulatory problems 
Male problems 
Tubal problems 
Coital problems 
Cervical problems 
Unexplained
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17
Q

Ix infertility - females (5)

A 
Day 2-5 FSH
Day 21 progesterone 
Rubella screen 
Triple swabs for STIs 
Tubal patency tests
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18
Q

What are the 3 types of tubal patency tests

A

HSG - Hysterosalpingogram
HyCoSy - Hystercontrastsynography
Laparoscopy + dye test

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19
Q

Ix infertility - males

A

Semen analysis incl volume, motility + couont

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20
Q

What extra Ix for infertility are conducted if the F is found to have an irregular cycle (4)

A

Testosterone
TFT
Prolactin
USS

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21
Q

What is Asherman’s syndrome

A

presence of scar tissue in the uterus or cervix. This scar tissue causes the uterine walls to be thicker, reducing the size of the uterus, and in severe cases, the walls can sometimes fuse together`

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22
Q

Hysteroscopy in infertility Ix

A

Assess uterine cavity for abnormalities

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23
Q

Laparoscopy + dye in infertility Ix

A

Methylene blue through cervix to assess tubal patency

24
Q

Hysterosalpingogram in infertility Ix

A

Radio-opaque contrast through cervix + assess xray

25
Q

Semen analysis - how long before must pt’s last ejaculation have been

A

2-7days

26
Q

Semen analysis - how long after sample taken must analysis be within

A

2 hours

27
Q

If 1st semen analysis comes back abnormal, what is the next step?

A

Repeat after 12 weeks

28
Q

Normal semen volume (WHO)

A

> 1.5ml

29
Q

Normal sperm count in semen (WHO)

A

> 15million/ml

30
Q

Normal progressive motility sperm (WHO)

A

> 32%

31
Q

What % of infertility is attributed to abnormal sperm count?

A

30%

32
Q

Def oligospermia

A

<15 million sperm/ml

33
Q

Def Asthenospermia

A

Absent/low motility

34
Q

Causes for abnormal sperm results (^6)

A 
Idiopathic 
Chemicals
Inadequate cooling 
Smoking/alcohol/Dx
Varicoele 
Antisperm Ab
35
Q

Ix low sperm count (3)

A

Hormones - testosterone primarily but also FSH,LH, prolactin, TSH
Serum Karyotyping
CF screen

36
Q

What condition are you looking for when serum karyotyping sperm?

A

Kleinfelters (XXY)

37
Q

Causes of high FSH in male infertility (2)

A

Anabolic steroids

High protein uptake

38
Q

Causes of norm FSH male infertility (3)

A

Vasectomy
Prev Hx mumps
Hx undescended testes

39
Q

Causes of low FSH male infertility (2)

A

ED

Pituitary tumour

40
Q

What is Natural IUI (intrauterine insemination)

A

Washed sperm are injected into uterine cavity during natural menstrual cycle

41
Q

What is Stimulated IUI

A

Washed sperm are injected into uterine cavity during natural menstrual cycle

+++
Using FSH/LH ovulation induction

42
Q

Who is eligable for IUI (2)

A

Unexplained subfertility

Cervical/sexual/male factors

43
Q

Pros of IUI (2)

A

Liver BR = 5-10%

Cheaper than IVF

44
Q

Cons IUI (3)

A

Lower success rate IVF
Tubes MUST be patent
Natural IUI req reg/normal cycles

45
Q

What are the 5 steps to IVF

A

1 - give RnRH analogue –> downregulation LH/FSH
2 - Re-add FSH (Menopur) –> lots of follicle recruitment
3 - Ovulation collection when 15-20mm + hCG (for LH)
36h after hCG added - USS + needle to suck eggs out
4 - Fertilation + culture 3-5days (incubator) –> blastocysts
5 - embryo transfer + progesterone pessaries 8w to support luteal phase

46
Q

Pro’s of IVF (2)

A

Success rate 25%

Fallopian tubes don’t need to be patent

47
Q

Cons IVF (2)

A

Normal ovarian resever req

LOTS of complications

48
Q

How to establish if woman has normal ovarian reserve for IVF

A

Se antimullerian

+ TV USS of no’ resting follicles in ovaries

49
Q

Complications IVF (6)

A 
Bladder/bowel perf 
Infection 
25% chance multip 
Ectopic risk incr
Miscarriage risk incr 
OHHS
50
Q

What is OHHS

A

Too much vasoactive substances –> increased permeability BV
Plasma leaks out of cells –> ascites + effusions
–> VTE
–> Incr risk AKI

51
Q

Tx OHHS (4)

A

Paracetamol
LMWH
Stockings (VTE)
Fl restrict

52
Q

What is ICSI

A

Intra-cytoplasmic sprm injection

53
Q

What is ICSI used for

A

Male subfertility

54
Q

What is pre-implnatation genetic diagnosis

A

removal of 1/2 cells from embryo @3 days
DNA examined + looked for abnormalities
Only transfer unaffected embryos back into uterus

55
Q

Who can use pre-implantation geentic diagnosis (3)

A

Carrier single gene defect e.g. CF
Sex selecting in sex linked disease e.g. haemophilia
Women >37

CP2 OBGYN (21 decks)

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