Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ONG > Subfertility > Flashcards

Subfertility Flashcards

1
Q

Percentage of couples affected by subfertility

A

15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define sub fertility

A

Conception has not occurred after a year of regular unprotected intercourse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is primary and secondary sub fertility

A

primary = never conceived, secondary = have conceived

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Proportion of causal factors (4 groups)

A

Annovulation 30%
Male factor 25%
Disorders of fertilisation 35% (Fallopian tubes 25%, sexual 5%, cervical <5%)
Unexplained 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what axis controls puberty

A

The hypothalamic–pituitary–gonadal axis (HPG axis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

after 8 years old GnRH pulses increase in amplitude and frequency so XXX and XXX release increases. This stimulates oestrogen release from the ovary.

A

FSH and LH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

normal length of cycle, blood loss and number of days menstruating

A

23-35 days, <8 days, <80ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

hormonal changes in the proliferative phase (day 5-13)

A
  • GnRH pulses stimulate LH and FSH -> follicular growth
  • follicles produce oestradiol and inhibit, neg feedback, suppress FSH, one follicle and oocyte matures
  • oestradiol continues to increase, pos feedback HPG, increase LH rapidly
  • ovulation 36 hrs after LH surge
  • oestradiol causes endometrium to reform and become proliferative
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what causes the LH surge

A

oestradiol rises causing positive feedback on HPG axis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what effect does oestradiol and inhibin have on FSH during proliferative phase

A

neg feedback, decrease FSH, only one matures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what type of endometrium does continuous exogenous progestogen maintain

A

secretory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Luteal/secretory phase (14-28) changes. Egg is released from the follicle, which becomes the corpus luteum that produces…

A
  • CL produces progesterone (and a bit of oestradiol) -> secretory changes in the endometrium (stromal cells enlarge, glands swell, blood supply increases)
  • then CL fails if not fertilised
  • progesterone and oestrogen fall withdrawing hormonal support
  • endometrium breaks down
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what happens if no fertilisation

A

Oestrogen and progesterone fall, endocrine breaks down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what hormone does the Corpus Luteum produce and what effect does it have

A

progesterone (and a little oestradiol). induces secretory changes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what day is a heart beat established

A

22 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what day is heart beat visible on TVUS

A

week after established ie 29 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what day does the zygote enter the uterus and become a blastocyst

A
  • day 4. develops fluid filled cavity to become a blastocyst.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what day does the outer layer of trophoblast implant to become the placenta later

A

6-12. 15% embryos lost at this stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what hormone does trophoblast produce and when does this peak and its effects

A

trophoblast produces hCG, peaks 12 weeks, maintains CL, which produces oestrogen and progesterone, turn secretory endometrium into decidua (rich in glycogen and lipids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

when is placenta morphology complete

A

12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Signs/Methods to detect ovulation

A
  • regular cycles, can spot, can have pelvic pain or increase discharge
  • temp dip 0.2 then rise 0.5 after ovulation
  • preovulation cervical mucus will form ‘spinnbarkeit’ on slide
  • PG levels (elevated mid luteal phase suggests ov). may need to repeat if irreg cycles.
  • urine predictor kit indicates LH surge. ov follows.
    (- ultrasound to serially monitor follicular growth and CL after ov but rarely done)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

presentation of PCOS

A

irregular or absent periods. dx exclusion so investigate other causes first.
typically obese, acne, hirtuism and oligo/amenorrhoea.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

describe PCOS TVUSS

A

multiple/>12, small/2-8mm follicles in an enlarged/>10ml/vol ovary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

dx criteria for PCOS. 2/3 of following…

A
  • PCO on TVUSS
  • Irreg periods (>35 days apart)
  • hirtuism (clinical, acne/excess hair) and/or biochemical (increase serum testosterone)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

4 blood tests for anovulation

A
  • FSH (increase in ov failure, low in hypothalamic disorders, normal PCOS)
  • AMH (high PCOS, low ov failure)
  • Prolactin (exclude prolactinoma)
  • TSH
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

PCOS ix

A
  • 4 bloods for anovulation (expect normal FSH, high AMH)
  • LH increased (not diagnostic)
  • serum testosterone increased (detects hirtuism. also increased in CAH or androgen secreting tumour)
  • TVUS
  • Screen for DM and ab lipids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

complications PCOS

A

T2DM, GDM, endometrial CA if unopposed oestrogen due to amenorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

treatment for PCOS 1) generally and not needing fertility

2) for fertility

A

1) - Lifestyle advice
- COCP if dont need fertility
- Anti-androgens (cyproterone or spironolactone) DONT get preg
- topical Eflornithene for hirtuism
2) - Clomiphene
- Metformin
- oral aromatase inhibitors (letrozole) not licensed yet
- lap ovarian diathermy
- Gonadotrophin induction with low dose step up regimen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

9 causes of anovulation

A
  • PCOS
  • Hypothalamic hypogonadism
  • Hyperprolactinaemia
  • Premature ovarian insufficiency
  • Kallman’s syndrome
  • Gonadal dysgenesis
  • Luteinised enraptured follicle syn
  • hypo/hyperthyroidism
  • Androgen-secreting tumours
30
Q

hypothalamic hypogonadism Ix findings and Mx

A

decrease in GnRH, decrease FSH/LH, decrease oestradiol

mx = weight gain

31
Q

Kallman’s syndrome mx

A

exogenous gonoadotrophins or GnRH pump. protect bones with COCP/HRT

32
Q

SS other than amenorrhoea that would indicate hyperprolactinaemia and mx

A

galactorrhea, headaches, bitemporal hemianopia

mx = dopamine agonist, surgery

33
Q

Ix findings for premature ovarian insufficiency

A

decrease oestrogen, decrease inhibin, increase FSH/LH, AMH low and low follicle count

34
Q

Side effects of ovulation induction (3)

A
  • Multiple pregnancy more likely with clomifene, letrozole and gonadotrophins
  • Ovarian hyperstimulation syndrome
  • ovarian and breast carcinoma
35
Q

RF for ovarian hyperstimulation syndrome

A
  • IVF more likely than just induction of ovulation
  • gonadotrophin stimulation
  • <35yrs
  • prev OHSS
  • PCO
36
Q

prevention OHSS

A

lowest effective dose, USS monitoring follicular growth and withdrawal gonadotrophins

37
Q

OHSS severe cases can cause

A

hypovolaemia, elec disturbances, ascites, thromboembolism, pul oedema

38
Q

PCOS induction of ovulation first line tx and second line

A

1st: clomifene or metformin (met can be used in conjunction as second line if women resistant to clomifene)
2nd: - gonadotrophin induction if above fail or hypothalamic hypogonadism (wt normal). recombinant or purified LH and FSH subcut. monitor follicles US, once one 17mm, inject hcg or recombinant LH to artificially start process.
- Laparoscopic ovarian diathermy. can test tubal patency and treat endometriosis or adhesions too.

39
Q

List the causes of abnormal/absent sperm release

A
  • Idiopathic oligospermia and asthenozoospermia (common)
  • drug exposure eg alcohol, smoke, sulfasalazine, anabolic steroids, solvents exposure
  • varicocele (present in 25% infertile men, 15% all, surgery doesn’t help)
  • anti-sperm antibodies (5% infertile men) often after vasectomy reversal. poor motility
  • infection eg epididymitis
  • mumps orchitis
  • testicular ab eg Klinefelter’s syn
  • obstruction in delivery eg CF
  • Hypothalamic problems
  • Kallmann’s syndrome (hypogonadotrophic hypogonadism)
  • Hyperprolactinaemia
  • Retrograde ejaculation eg into bladder
40
Q

Define Oligospermia and severe oligospermia

A

<15 million/ml, <5 million/ml

41
Q

what is asthenospermia

A

absent or low motility

42
Q

Detection of tubal damage

A
  • lap and dye test (methylene blue)
  • hysteroscopy
  • hysterosalpingogram (HSG)
43
Q

how many days does it take to develop sperm

A

70

44
Q

where does spermatogenesis take place and what is it dependent on

A

testis, dependent on LH (acting via testosterone production in leydig cells) and FSH

45
Q

What cells do FSH and testosterone control

A

Sertoli cells, which synth and transport sperm

46
Q

testosterone and other steroids XXX release of LH, creating a XXX feedback loop with the HPA

A

inhibit

negative

47
Q

Ix for male factor and when

A

semen analysis at 2-7/7 abstinence. if abnormal repeat 12/52

if abnormal persistently then examination and Ix male follow

48
Q

Normal semen

  • volume
  • sperm count
  • progressive motility
A

> 1.5ml
15million/ml
32%

49
Q

tests following azoospermia

A

FSH, LH, testosterone, prolactin and TSH

50
Q

Causes azoospermia

A

hypogonadotrophic hypogonadism (v low FSH, LH, test)
hyperprolactinaemia
thyroid
primary test failure eg cryptorchidism, surgery, radiochemo

51
Q

mx male factor sub fertility

A
  • lifestyle
  • hypogonadotropohic hypogonadism -> x3 weekly subcut LH/FSH (+- hcg) 6-12m
  • assisted conception: IUI, IVF (+- ICSI if severe, Intracytoplasmic Sperm Injection), Surgical sperm retrieval then ICSI and IVF
52
Q

causes of failure to fertilise (5)

A 
PID
Endometriosis
previous surgery/sterilisation
cervical problems
sexual problems
53
Q

what is cryopreservation of ovarian/testicular tissue

A
  • done at laparoscopy before sterilise women that are about to have cancer tx. after oncology tx, check ovarian sample mets and graft back in
  • similar with testicular tissue done in prepubertal boys can preserve fertility
54
Q

3 main complications of assisted conception

A

super ovulation, egg collection complications (intraperitoneal haemorrhage and infection, <1%), pregnancy complications eg ectopic, multiple

ICSI ass with slight increase genetic abs, linked due to increase rate in severe male factor infertility.

55
Q

what is the success rate of 1 IVF cycle and egg/embryo freezing

A

30-50% if <35. decreases with age

56
Q

how to measure ovulation in natural cycle IUI

A

urinary LH

57
Q

What is used to stimulate ov in IUI

A

gonadotrophin

58
Q

stimulated IUI live birth rate per cycle and multiple pregnancy risk compared to IVF

A

IUI: 5-10% success, 15% multiple pregnancy risk
IVF: <36 = 35%, >40 = 10% success

59
Q

what hormones given to the recipient for receiving oocyte from donation

A

progesterone and oestrogen to prepare the endometrium

60
Q

when is ICSI needed

A

male factor insufficiency eg azoospermia and asthenospermia

61
Q

TRUE OR FALSE:

tubes have to be patent for IVF

A

FALSE

tubes do not have to be patent as fertilisation occurs outside

62
Q

TRUE OR FALSE:
Can you do IVF with a low ovarian reserve ie ovarian failure
BONUS POINT: how do you measure ovarian reserve

A

FALSE
need enough eggs. can’t do if ovarian failure
ovarian reserve measured by serum AMH (or TVUSS to count AFC)

63
Q

what cells are used for preimplantation genetic diagnosis

A

3-5 trophectoderm cells (-> placenta) from the blastocyst

64
Q

which couples is preimplantation genetic diagnosis useful for (3 egs)

A
  • risk of aneuploidy if have chromosome translocations
  • carriers of single gene defects eg CF
  • can sex baby so dont pass on X-linked recessive disorders eg haemophilia
65
Q

what molecular techniques used in preimplantation genetic diagnosis

A
  • PCR
  • Next gen sequencing
  • karyomapping
  • assay comparative genomic hybridisation
  • FISH
66
Q

2 types of IVF in the multiple follicular stage, when gonadotrophin (FSH and LH) is given for 2 weeks, then need to prevent ov

A
  • long protocol: daily GnRH at day 21 for 2-3 weeks. once confirm quiescence, then start gonadotrophin stimulations. GnRH analogue continued with gonadotrophin stimulations til just before collection.
  • short: dont do pit suppression before stimulations. instead daily GnRH added from day 5 of gonadotrophin stim til before collect
67
Q

what drug injected to do final oocyte maturation

A

hCG or LH

68
Q

how eggs collected

A

35-38hrs after injection for maturation, IV sed, TV aspiration with USS guidance

69
Q

what is given for luteal phase support after embryo transfer

A

PG or hCG til weeks 4-8

70
Q

when are embryos cultured til

A

til cleavage (day 2-3) or blastocyst (5-6)

71
Q

how many should you implant if >40

A

no more than 2

ONG (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions