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Year 3 Repro (JK) > Subfertility/infertility > Flashcards

Subfertility/infertility Flashcards

1
Q

How many couples have infertility issues?

A

1 in 7

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2
Q

What % of couples are pregnant within one year and 2 years of trying?

A

1 year - 80%

2 years - 90%

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3
Q

Infertility

A

inability to conceive after 12 months of regular intercourse without use of contraception

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4
Q

4 questions you ask yourself with infertility?

A

are eggs available?
are sperm available?
can they meet?
can embryo implant?

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5
Q

Questions in female history

A

psychological - duration of infertility - previous contraception - fertility in previous issues - previous pregnancies and complications - menstrual history - medical and surgical history - sexual history - previous investigations

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6
Q

Female examination

A

abdomen - pelvic - BMI - height - weight - fat and hair distribution - galactorrhoea

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7
Q

What BMI is considered for IVF referral?

A

under 30

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8
Q

What can galactorrhoea be a sign of?

A

prolactinoma

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9
Q

Cause of mild hirsutism

A

PCOS

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10
Q

Causes of severe hirsutism

A

late onset adrenal hyperplasia

androgen secreting tumour eg adrenal or ovarian

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11
Q

Biochemical measurements used in androgen excess

A 
DHA 
DHAS
SHBG
17-OH progesterone
testosterone
androsterodione
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12
Q

Clinical measurement of androgen excess and what it looks at

A

Ferriman Gallwey score

hair on upper lip, face, chest, abdomen

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13
Q

Name one sign of andogen excess

A

acanthosis nigricans

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14
Q

findings on female pelvic examination of note

A

tenderness
masses
pelvic distortion
fixed retroversion

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15
Q

3 symptoms of fibroids

A

pressure symptoms
period problems
infertility

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16
Q

Male history

A

sexual history - previous investigations and treatment - previous fertility - medical and surgical history - occupational history

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17
Q

Male examination

A

weight - height - BMI - fat and hair distribution - abdominal and inguinal exam - genital exam

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18
Q

findings/what to look for in genital exam of males

A 
testis 
varicocoele 
penis 
epididymis
vas deferens
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19
Q

Causes of epididymitis

A

STD - chlamydia trachomatis, gonorrhoea, NSTD

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20
Q

What should you think of if small testicular size?

A

Klinefelters syndrome - 47 XXY

21
Q

Importance of vas deferens in infertility

A

CF mutations and congenital bilateral absence of vas deferens

22
Q

Hypospadias

A

urethral opening on underside of penis

23
Q

varicocoele

A

abnormal torsion and dilation of veins

24
Q

How to assess man’s sperm

A

computerised semen analysis

25
Q

How to determine if eggs are available?

A

hormonal levels

26
Q

Usually refer if no pregnancy in 1 year, exceptions to this rule are…

A 
period irregularity 
PMH 
testicular problems 
abnormal testis 
age 
HIV/Hep B 
anxiety
27
Q

female Age for referral - after trying for how long?

A

under 35 - 1 year
35-45 - 6 months
rarely refer after 45

28
Q

Baseline female investigations

A

rubella immunity
chlamydia
TSH
mid luteal progesterone if regular periods
1-5 day FSH, LH, PRL, TSH, testosterone if irregular

29
Q

Male baseline investigations

A

semen analysis

30
Q

Investigations

A

Pelvic USS
semen analysis repeat
tubal patency test - HyCoSy

31
Q

3 parts of PCOS

A

androgen excess - hirsutism and testosterone
USS polycystic ovaries
infrequent periods - anovulation

32
Q

How can ovulation be achieved?

A

clomifene, gonadotrophins, GnRH

33
Q

What type of medication is clomifene?

A

selective oestrogen receptor modulator

34
Q

Dose of clomifene

A

50mg-150mg day 2-6

35
Q

If there is amenorrhoea what is important to do if using clomifene?

A

prime with progestogen

36
Q

Monitoring of clomifene

A

follicle scan in 1st cycle

37
Q

side effects of clomifene

A

vasomotor and visual

38
Q

2 reasons for using gonadotrophins for ovulation

A

no ovulation with clomifene

ovulation but no pregnancy with clomifene

39
Q

What medication is used for gonadotrophin treatment?

A

FSH injection for 3-6 cycles

40
Q

Male factor infertility - what can be used?

A 
ICSI 
donor insemination 
intra-uterine insemination 
IVF
surgery eg reversal of vasectomy, surgical sperm retrieval
41
Q

3 testicular causes of azoospermia

A

normogonadotrophic
hypogonadism
hypergonadotrophic

42
Q

3 post-testicular causes of azoospermia

A

iatrogenic, congenital, infective

43
Q

Investigations for azoospermia

A

history and examination
CF screen
FSH,LH,PRL, testosterone, karyotype

44
Q

2 methods of surgical sperm retrieval

A

micro epididymal sperm aspiration

testicular sperm extraction

45
Q

Sexual problems solution

A

psychosexual counselling

artificial insemination - timed at home or Intra-uterine in clinic

46
Q

Describe IVF

A
  1. eggs harvested from ovary
  2. eggs fertilised in lab with sperm
  3. embryos undergo cell division
  4. Embryos transferred to the womb
47
Q

Describe ICSI

A

injection of mature eggs with single sperm
incubate overnight
transfer embryo at day 5

48
Q

cryopreservation

A

freezing eggs

49
Q

Changing society within fertility examples

A

obesity - lesbian couples - single women - post humous insemination - older women

Year 3 Repro (JK) (33 decks)

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