subfertility Flashcards
GTGs and SIPs
1
Q
risk of miscarriage 30-34y
A
15%
2
Q
risk of miscarriage 35-39y
A
24%
3
Q
risk of miscarriage 40-44y
A
51%
4
Q
risk of miscarriage >45y
A
93%
5
Q
risks for mothers >35yo
A
Stillbirth, ectopic, miscarriages, GDM, placenta previa, placental abruption, PIH, C/S
6
Q
best test of ovarian reserve
A
AMH
7
Q
% of IVF cycles using electively frozen eggs
A
<2%
8
Q
risks of elective egg freezing
A
- Age –> PET, GDM, C/S
- OHSS
- Procedural –> bleeding, infection, VTE
9
Q
10 frozen egg cumulative live birth rate <35yo
A
42.8%
10
Q
10 frozen egg cumulative live birth rate >36yo
A
25.2%
11
Q
commonest treatment related adverse outcome of IVF
A
multiple pregnancies
12
Q
risks of multiple pregnancies
A
PIH PTL PPH OVB GDM
13
Q
rate of multiple pregnancies in ART (2009 vs. 2014)
A
24% vs. 15.9%
14
Q
incidence of mild OHSS
A
33%
15
Q
combined incidence of moderate-severe OHSS
A
3.1-8%
16
Q
After OHSS, risk of PET
A
21.2%
17
Q
after OHSS, risk of PTL
A
36%
18
Q
risk factors for OHSS
A
previous OHSS
PCOS
increased AFC or AMH
Multiple pregnancy
19
Q
Protective factor against OHSS
A
use of GnRH antagonists
20
Q
Criteria for critical OHSS
A
- tense ascites or hydrothorax
- Hct >0.55
- WBC >25
- Oliguria/anuria
- VTE
- ARDS
21
Q
risk of miscarriage 25-29y
A
11-12%
22
Q
risk of miscarriage 20-24y
A
9-11%
23
Q
% of congenital CMV neonates symptomatic at birth
A
10-15%
24
Q
% of shoulder dystocias complicated by brachial plexus injuries
A
2.3-16%
25
% of brachial plexus injuries with permanent damage
<10%
26
incidence of chronic pelvic pain after ONE episode PID/TOA
12%
27
incidence of chronic pelvic pain after TWO episodes of PID/TOA
30%
28
incidence of chronic pelvic pain after THREE episodes of PID/TOA
67%
29
raised AFP in 2nd trim screen
```
FGR
placental abruption
female demise >24/40
PTL
spont misc
```
30
raised bHCG and inhibin A 2nd trim screen
```
PTL
PIH
PET
IUFD
FGR
```
31
low estriol 2nd trim screen
oligo
IUFD
SGA/LBW
spont misc
32
low PAPP-A 1st trim screen
```
PET
LBW
PIH
PTL
Miscarriage
```
33
low bHCG 1st trim screen
spont misc
| LBW
34
combined test for downs
PAPP-A
bHCG
Nuchal translucency
35
quadruple test
AFP
bHCG
estriol
inhibin A
36
risk of ovarian failure after bilateral ovarian endometrioma cystectomy
2.4%
37
intraop complication rate for DIE
2.1%
38
total postop complication rate for DIE
13. 9%
| 9. 5% minor, 4.6% major
39
recurrence rate of DIE at 2 years following surgery
5-25%
40
ovarian conservation at TAH for endometriosis - risk of recurrent pain
6x greater
41
ovarian conservation at TAH for endometriosis - risk of reoperation
8.1x greater
42
according to NICE, what % of couples will conceive in 1 year
80%
43
according to NICE, what % of couples will conceive within 2 years (cumulative rate)
>90% (of those who did not conceive, half will do so in the second year)
44
incidence of miscarriage following ART (singleton)
15-20%
45
incidence of ectopic pregnancy following ART
2-8%
46
OR of stillbirth following ART
2.4
47
PTL after ART (singleton)
11.2% (may be iatrogenic)
48
OR of placenta previa following ART
3.76
49
absolute risk of structural abnormalities in fetus following ART
30-40% increased incidence;
| absolute risk 6.5-7%
50
absolute increase in risk PIH/PET following ART
~2%
51
absolute increase in risk GDM following ART
~1%
52
% cause of male infertility
30%
53
% cause of infertility by ovulatory disorder
25%
54
% cause of infertility by tubal damage
20%
55
% cause of infertility by uterine or peritoneal disorders
10%
56
% unexplained infertility contribution
25%
57
normal semen volume
>1.5ml
58
normal pH semen
>7.2
59
normal sperm concentration
>15mil
60
normal total sperm number
>39mil
61
normal total motility semen analysis
40% or more motile;
| or 32% of more with progressive motility
62
normal sperm vitality
58% or more live spermatozoa
63
normal sperm morphology
4% or more normal forms
64
ovarian reserve testing: AFC low response
<4
65
ovarian reserve testing: AFC high response
>16
66
ovarian reserve testing: AMH low response
<5.4
67
ovarian reserve testing: AMH high response
>25 pmol/l
68
ovarian reserve testing: FSH low response
>8.9
69
ovarian reserve testing: FSH high response
<4
70
when to check progesterone to confirm ovulation
day 21 of a 28 day cycle (mid-luteal phase)
71
how long to delay pregnancy after rubella vaccination
>1/12
72
how long to delay pregnancy after RAIT
>6/12
73
average pregnancy rate for ICSI
33% per ET
74
low FSH, low testosterone
hypogonadotrophic; PRE-Testicular:
- kallmanns
- prader willi
- CHARGE
- pituitary tumor
- TBI
75
high FSH, low testosterone
hypergonadotrophic; TESTICULAR:
- klinfelter
- noonan
- cryptorchism
- varicocele
- idiopathic
76
FSH normal, testosterone normal
```
post-testicular:
CAVD,
CF,
infxn,
vasectomy,
immotile cilia, sexual dysfunction
```
77
incidence of POI
1%
78
incidence of early ovarian ageing
10%
79
early ovarian ageing definition
low ovarian reserve and accelerated loss of ovarian follicles in the early thirties (leading to menopause <45yo)
80
rising FSH in menopause naturally leads to
- advanced follicle recruitment
- shortened cycles
- increased multifollicular development (increased risk of twinning)
- accelerated rate of follicle loss
81
risk of OHSS in PCOS
10%
82
VTE risk in OHSS
0.7-10%
83
overall prevalence of congenital uterine anomalies
5.5%
84
incidence of MRKH
1:5000 births
85
investigation of choice for congenital uterine anomalies
3D TVS +/- MRI
86
management for functioning rudimentary horns
surgical removal
87
management for bicornuate uterus/didelphys
none recommended
88
management for septate uterus
hysteroscopic metroplasty or hysteroscopic transcervical diversion
89
what proportion of MRKH have renal anomaly
40%
| 12% have absent kidney
90
prognosis without intervention for unexplained recurrent miscarriage
75%
91
% of recurrent miscarriages that are unexplained
50%
92
antiphospholipid syndrome in recurrent miscarriage
15% (2-3% in general population only)
93
incidence of genetic abnormalities in parents with recurrent misc
2-5%
| robertsonian translocation 2%
94
incidence of genetic abnormalities in recurrent misc
30-57%
95
subfertility affects?
15% (1/6-7) of population
96
endometrial thickness for embryo transfer
>5mm
97
clomifene will be successful in what %
ovulation will occur in 70-80%
98
failure of clomifene
10%
99
resistance to clomifene
20%
100
% combined male/female fertility factors
40%
101
PCOS accounts for what % of women with anovulatory infertility
80-90%
102
PCOS - what BMI prior to ovulation induction
<30; weight loss 5-10% can be very effective
103
unexplained infertility - how long to wait before IVF
attempt to conceive for a total of 2 years (including pre-referral period) before IVF
104
mild OHSS ovarian size
<8cm
105
moderate OHSS ovarian size
8-12cm
106
severe OHSS ovarian size
>12cm
107
when to perform endometrial scratch
7 days prior to onset of menstruation, immediately before stimulation treatment
108
IVF: number of cycles up to age 40
3
109
IVF: number of cycles for age 40-42
1 if no evidence of low ovarian reserve and no previous IVF
110
IVF: success >43yo
5%
111
turner syndrome in what % of first trimester miscarriages
10%
112
most common cardiac anomaly in turner's syndrome
bicuspid aortic vale, 30%
113
risk of aortic dissection in turners syndrme
absolute risk 1%; highest risk in third trimester and postpartum.
114
pregnancy CI in TS (regarding aortic dissection)
- aorta diameter ?35mm or 25mm2
- history of aortic surgery
- uncontrolled HTN despite Rx
- presence of bicuspid valve or coarctation are risk factors
115
how often to do cardiac/aortic MRI in TS women considering pregnancy
every 5 years
116
conception rate in TS
8%;
| increased risk of miscarriage 31-45%
117
TS management in pregnancy
- 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
TS - regular BB if risk factors for dissection:
- pre-existing aortic dilation
- bicuspid aortic valve
- coarctation
- HTN
119
surrogacy - when is parental order given
not before 6 weeks;
| application must be made before 6 months
120
most common electrolyte disturbance in OHSS
hyponatremia, 56%
121
mechanism of action of metformin
enhances insulin sensitivity at the cellular level
122
prevalence of endometriosis in infertile women
50% (compared to 2-10% general population)
