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subfertility Flashcards

GTGs and SIPs

1
Q

risk of miscarriage 30-34y

A

15%

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2
Q

risk of miscarriage 35-39y

A

24%

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3
Q

risk of miscarriage 40-44y

A

51%

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4
Q

risk of miscarriage >45y

A

93%

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5
Q

risks for mothers >35yo

A

Stillbirth, ectopic, miscarriages, GDM, placenta previa, placental abruption, PIH, C/S

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6
Q

best test of ovarian reserve

A

AMH

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7
Q

% of IVF cycles using electively frozen eggs

A

<2%

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8
Q

risks of elective egg freezing

A
  1. Age –> PET, GDM, C/S
  2. OHSS
  3. Procedural –> bleeding, infection, VTE
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9
Q

10 frozen egg cumulative live birth rate <35yo

A

42.8%

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10
Q

10 frozen egg cumulative live birth rate >36yo

A

25.2%

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11
Q

commonest treatment related adverse outcome of IVF

A

multiple pregnancies

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12
Q

risks of multiple pregnancies

A 
PIH
PTL
PPH
OVB
GDM
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13
Q

rate of multiple pregnancies in ART (2009 vs. 2014)

A

24% vs. 15.9%

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14
Q

incidence of mild OHSS

A

33%

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15
Q

combined incidence of moderate-severe OHSS

A

3.1-8%

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16
Q

After OHSS, risk of PET

A

21.2%

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17
Q

after OHSS, risk of PTL

A

36%

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18
Q

risk factors for OHSS

A

previous OHSS
PCOS
increased AFC or AMH
Multiple pregnancy

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19
Q

Protective factor against OHSS

A

use of GnRH antagonists

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20
Q

Criteria for critical OHSS

A
  1. tense ascites or hydrothorax
  2. Hct >0.55
  3. WBC >25
  4. Oliguria/anuria
  5. VTE
  6. ARDS
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21
Q

risk of miscarriage 25-29y

A

11-12%

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22
Q

risk of miscarriage 20-24y

A

9-11%

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23
Q

% of congenital CMV neonates symptomatic at birth

A

10-15%

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24
Q

% of shoulder dystocias complicated by brachial plexus injuries

A

2.3-16%

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25
Q

% of brachial plexus injuries with permanent damage

A

<10%

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26
Q

incidence of chronic pelvic pain after ONE episode PID/TOA

A

12%

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27
Q

incidence of chronic pelvic pain after TWO episodes of PID/TOA

A

30%

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28
Q

incidence of chronic pelvic pain after THREE episodes of PID/TOA

A

67%

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29
Q

raised AFP in 2nd trim screen

A 
FGR
placental abruption
female demise >24/40
PTL
spont misc
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30
Q

raised bHCG and inhibin A 2nd trim screen

A 
PTL
PIH
PET
IUFD
FGR
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31
Q

low estriol 2nd trim screen

A

oligo
IUFD
SGA/LBW
spont misc

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32
Q

low PAPP-A 1st trim screen

A 
PET
LBW
PIH
PTL
Miscarriage
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33
Q

low bHCG 1st trim screen

A

spont misc

LBW

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34
Q

combined test for downs

A

PAPP-A
bHCG
Nuchal translucency

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35
Q

quadruple test

A

AFP
bHCG
estriol
inhibin A

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36
Q

risk of ovarian failure after bilateral ovarian endometrioma cystectomy

A

2.4%

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37
Q

intraop complication rate for DIE

A

2.1%

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38
Q

total postop complication rate for DIE

A
  1. 9%

9. 5% minor, 4.6% major

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39
Q

recurrence rate of DIE at 2 years following surgery

A

5-25%

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40
Q

ovarian conservation at TAH for endometriosis - risk of recurrent pain

A

6x greater

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41
Q

ovarian conservation at TAH for endometriosis - risk of reoperation

A

8.1x greater

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42
Q

according to NICE, what % of couples will conceive in 1 year

A

80%

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43
Q

according to NICE, what % of couples will conceive within 2 years (cumulative rate)

A

> 90% (of those who did not conceive, half will do so in the second year)

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44
Q

incidence of miscarriage following ART (singleton)

A

15-20%

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45
Q

incidence of ectopic pregnancy following ART

A

2-8%

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46
Q

OR of stillbirth following ART

A

2.4

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47
Q

PTL after ART (singleton)

A

11.2% (may be iatrogenic)

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48
Q

OR of placenta previa following ART

A

3.76

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49
Q

absolute risk of structural abnormalities in fetus following ART

A

30-40% increased incidence;

absolute risk 6.5-7%

50
Q

absolute increase in risk PIH/PET following ART

51
Q

absolute increase in risk GDM following ART

52
Q

% cause of male infertility

53
Q

% cause of infertility by ovulatory disorder

54
Q

% cause of infertility by tubal damage

55
Q

% cause of infertility by uterine or peritoneal disorders

56
Q

% unexplained infertility contribution

57
Q

normal semen volume

58
Q

normal pH semen

59
Q

normal sperm concentration

60
Q

normal total sperm number

61
Q

normal total motility semen analysis

A

40% or more motile;

or 32% of more with progressive motility

62
Q

normal sperm vitality

A

58% or more live spermatozoa

63
Q

normal sperm morphology

A

4% or more normal forms

64
Q

ovarian reserve testing: AFC low response

65
Q

ovarian reserve testing: AFC high response

66
Q

ovarian reserve testing: AMH low response

67
Q

ovarian reserve testing: AMH high response

A

> 25 pmol/l

68
Q

ovarian reserve testing: FSH low response

69
Q

ovarian reserve testing: FSH high response

70
Q

when to check progesterone to confirm ovulation

A

day 21 of a 28 day cycle (mid-luteal phase)

71
Q

how long to delay pregnancy after rubella vaccination

72
Q

how long to delay pregnancy after RAIT

73
Q

average pregnancy rate for ICSI

A

33% per ET

74
Q

low FSH, low testosterone

A

hypogonadotrophic; PRE-Testicular:

  • kallmanns
  • prader willi
  • CHARGE
  • pituitary tumor
  • TBI
75
Q

high FSH, low testosterone

A

hypergonadotrophic; TESTICULAR:

  • klinfelter
  • noonan
  • cryptorchism
  • varicocele
  • idiopathic
76
Q

FSH normal, testosterone normal

A 
post-testicular:
CAVD,
CF,
infxn,
vasectomy,
immotile cilia, sexual dysfunction
77
Q

incidence of POI

78
Q

incidence of early ovarian ageing

79
Q

early ovarian ageing definition

A

low ovarian reserve and accelerated loss of ovarian follicles in the early thirties (leading to menopause <45yo)

80
Q

rising FSH in menopause naturally leads to

A
  • advanced follicle recruitment
  • shortened cycles
  • increased multifollicular development (increased risk of twinning)
  • accelerated rate of follicle loss
81
Q

risk of OHSS in PCOS

82
Q

VTE risk in OHSS

83
Q

overall prevalence of congenital uterine anomalies

84
Q

incidence of MRKH

A

1:5000 births

85
Q

investigation of choice for congenital uterine anomalies

A

3D TVS +/- MRI

86
Q

management for functioning rudimentary horns

A

surgical removal

87
Q

management for bicornuate uterus/didelphys

A

none recommended

88
Q

management for septate uterus

A

hysteroscopic metroplasty or hysteroscopic transcervical diversion

89
Q

what proportion of MRKH have renal anomaly

A

40%

12% have absent kidney

90
Q

prognosis without intervention for unexplained recurrent miscarriage

91
Q

% of recurrent miscarriages that are unexplained

92
Q

antiphospholipid syndrome in recurrent miscarriage

A

15% (2-3% in general population only)

93
Q

incidence of genetic abnormalities in parents with recurrent misc

A

2-5%

robertsonian translocation 2%

94
Q

incidence of genetic abnormalities in recurrent misc

95
Q

subfertility affects?

A

15% (1/6-7) of population

96
Q

endometrial thickness for embryo transfer

97
Q

clomifene will be successful in what %

A

ovulation will occur in 70-80%

98
Q

failure of clomifene

99
Q

resistance to clomifene

100
Q

% combined male/female fertility factors

101
Q

PCOS accounts for what % of women with anovulatory infertility

102
Q

PCOS - what BMI prior to ovulation induction

A

<30; weight loss 5-10% can be very effective

103
Q

unexplained infertility - how long to wait before IVF

A

attempt to conceive for a total of 2 years (including pre-referral period) before IVF

104
Q

mild OHSS ovarian size

105
Q

moderate OHSS ovarian size

106
Q

severe OHSS ovarian size

107
Q

when to perform endometrial scratch

A

7 days prior to onset of menstruation, immediately before stimulation treatment

108
Q

IVF: number of cycles up to age 40

109
Q

IVF: number of cycles for age 40-42

A

1 if no evidence of low ovarian reserve and no previous IVF

110
Q

IVF: success >43yo

111
Q

turner syndrome in what % of first trimester miscarriages

112
Q

most common cardiac anomaly in turner’s syndrome

A

bicuspid aortic vale, 30%

113
Q

risk of aortic dissection in turners syndrme

A

absolute risk 1%; highest risk in third trimester and postpartum.

114
Q

pregnancy CI in TS (regarding aortic dissection)

A
  • aorta diameter ?35mm or 25mm2
  • history of aortic surgery
  • uncontrolled HTN despite Rx
  • presence of bicuspid valve or coarctation are risk factors
115
Q

how often to do cardiac/aortic MRI in TS women considering pregnancy

A

every 5 years

116
Q

conception rate in TS

A

8%;

increased risk of miscarriage 31-45%

117
Q

TS management in pregnancy

A
  • MDT
  • assessment at end of 1st and 2nd trimesters
  • assessment monthly in third trimester
  • echo at each visit, and MRI if increased aortic size
  • delivery in center where acute cardiac surgery is available
  • keep PN for 5/7
118
Q

TS - regular BB if risk factors for dissection:

A
  • pre-existing aortic dilation
  • bicuspid aortic valve
  • coarctation
  • HTN
119
Q

surrogacy - when is parental order given

A

not before 6 weeks;

application must be made before 6 months

120
Q

most common electrolyte disturbance in OHSS

A

hyponatremia, 56%

121
Q

mechanism of action of metformin

A

enhances insulin sensitivity at the cellular level

122
Q

prevalence of endometriosis in infertile women

A

50% (compared to 2-10% general population)

part 2 (21 decks)

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