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Gynae > subfertilty/infertility > Flashcards

subfertilty/infertility Flashcards

1
Q

when should investigations take place

A

after 1 year of trying

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2
Q

when can investigations be done earlier

A

> 35, amenorrhoea, past PID, oligomenrrhoea, cancer treatments, undescended testis

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3
Q

initial management

A

advise to stop smoking, lose weight if BMI >29. 0.4mg folic acid a day. decr stress

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4
Q

what should ask her about

A

menstrual hx, prev pregnancies, contraception, Hx pelvic infection, abdo surgery, drugs

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5
Q

what should ask him about

A

puberty, prev fatherhood, prev surgery, illnesses- venereal, mumps; job, erectile problems

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6
Q

what should ask them both about

A

technique, how often doing it, previous tests

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7
Q

examination

A

general health, sexual development, abdomen and pelvis, seminal analysis if abnormal- endo/penile abnormalities, varicocoeles, normal testes, BMI of man

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8
Q

female causes of subfertility

A

anovulation or infreq ovulation; tubal damage; uterine factors eg adhesions, ashermans syndrome

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9
Q

if suspect anovulation what blood tests can you do

A

serum mid luteal progesterone - 7 days before expected period >30 is indicative of ovulation (day 21); day 5 FSH, day 5 LH, blood prolactin.

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10
Q

what does day 5 FSH show

A

> 10 indicates poor response to ovarian stimulation- may indicate primary ovarian failure, but FSH is pulsatile in its release

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11
Q

what does day 5 LH show

A

for PCOS

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12
Q

tests of tubal patency

A

screen for chlamydia first. hysterosalpingogram (contrast X ray), laparoscopy with dye

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13
Q

what does a hysterosalpingogram demonstrate

A

uterine anatomy and tubal ‘fill’ and ‘spill’

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14
Q

what should you give pre hysterosalpingogram

A

cefradine with metronidazole and 5 days post op to prevent pelvic infection

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15
Q

what can be seen on laparoscopy with dye

A

pelvic organs visualised, methylene dye injected through the cervix

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16
Q

what treatment can be given if the cause is hyperprolactinaemia

A

bromocriptine

17
Q

treatment of azoospermia

A

in 50% the sperm are still being produced just not ejaculated. ICSI- intra cytoplasmic sperm injection

18
Q

treatment with problems of sperm deposition

A

eg erectile dysfunction. artificial insemination

19
Q

treatment if anovulation

A

class 1- hypothalamic pituitary failure- pulsed GnRH. class 2- hypothalamic pituitary dysfunction- clomifene

20
Q

treatment of tubal problems

A

surgery

21
Q

what is clomifene

A

selective estrogen receptor modulator used in anovulation (SERM)

22
Q

what happens in IVF

A

ovaries stimulated, ova collected, fertilised, 2 embryos returned

23
Q

where does spermatogenesis take place

A

seminiferous tubules

24
Q

which cells produce testosterone

A

leydig cells

25
Q

what stimulates sertoli cells

A

testosterone and FSH

26
Q

what do sertoli cells produce

A

metabolic support of germ cells and spermatogenesis

27
Q

causes of male subfertility

A

idiopathic- testes small and incr FSH; asthenozoospermia/teratozoospermia; varicocoele; genital tract infections; sperm autoimmunity; congenital; klinefelters; obstructive azoospermia; gonadotrophin deficiency

28
Q

what is asthenozoospermia

A

motility decreases due to structural problems

29
Q

what is teratozoospermia

A

excess of abnormal forms

30
Q

what is the main tool for male subfertility

A

ICSI

31
Q

what may there be a hx of in male subfertility

A

testicular maldescent, trauma, torsion

32
Q

what is the primary and secondary subfertility

A

primary- never conceived before. secondary- have conceived before

33
Q

what is kallmans syndrome

A

failure to start puberty or to complete it. decr GnRH

34
Q

what is sheehans syndrome

A

hypopituitarism due to ischaemic necrosis due to blood loss and hypovolaemia shock in childbirth

35
Q

ovulation disorders

A

premature ovarian failure, radio/chemo, surgical removal, autoimmune, turners, androgen insensitivity

36
Q

tubal problems

A

pelvic infection, endometriosis, previous surgery

37
Q

what does the BMI need to be for IVF

A
38
Q

what is the patient at risk of in assisted reproduction

A

ovarian hyperstimulation syndrome

39
Q

signs of ovarian hyperstimulation syndrome

A

ascites, pleural effusion, enlarged ovary- can get torted and twisted

Gynae (18 decks)

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