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Repro > Infertility - Women > Flashcards

Infertility - Women Flashcards

1
Q

When should a couple be referred to a fertility clinic?

A

Only if they’re been trying unsuccessfully for atleast 12 months or have other problems such as:

  • Irregular Periods
  • Relevant PMH
  • Testicular Problems
  • HIV/HEP B
  • Serious Anxiety

> 35s can be referred after only 6 months

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2
Q

List some of the major causes for Female Infertility?

A
  • Ovulatory Disorders
  • Androgen-secreting Adrenal Tumour
  • Prolactinoma
  • Fibroids
  • Endometriosis
  • Tumours
  • Tubal Block
  • Unexplained
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3
Q

What are the categories of ovulatory disorders?

A

Group 1 = Hypothalamic-Pituitary failure
Group 2 = Hypothalamic-Pit-Ovarian dysfunction (mainly PCOS)
Group 3 = Ovarian Failure

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4
Q

How would we treat someone with a Group 1 Ovulatory Disorder?

A

Optimise their BMI
Moderate exercise if very active
Ovulation induction with GnRH or LH

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5
Q

PCOS is the main Group 2 ovulatory disorder, what is it?

A

Polycystic Ovary Syndrome

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6
Q

How do we diagnose PCOS?

A

The Rotterdam Criteria. 2 out of 3 is +ve:

  • Androgen excess (Ferriman Gallway Score)
  • Infrequent Periods (Anovulation)
  • US
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7
Q

What signs would you look for to indicate androgen excess?

A
  • Hirsutism
  • Acanthosis Nigricans
  • Moderately raised testosterone (test DHEAS for androgen secreting tumours)

Score Androgen excess by a Ferriman Galway Score

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8
Q

How do we treat PCOS?

A

1) Optimise BMI

2) Ovulation Induction with Clomifene or Gonadotrophins

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9
Q

How does Clomifene work?

A
  • Antagonises oestrogen receptors in pituitary.
  • Causes hypothalamus to detect LOW oestrogen
  • Hypothalmus stimulates increased secretion of FSH

Use 50-150mg on days 2-6, prime with progesterone if amenorrhoeic

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10
Q

What must we be careful of when using clomifene?

A

Ovarian Hyperstimulation
Multiple Pregnancy

Hence why we do Follicle Scanning in the 1st cycle and adjust the dose if required

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11
Q

When would we use Gonadotrophins to induce ovulation instead of clomifene?

A

If clomifene produces no ovulation or they do but they still don’t get pregnant.

Up to 3-6 cycles using FSH injection

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12
Q

How would you spot an androgen-secreting adrenal tumour?

A

Testosterone will be very elevated (much higher than in PCOS)
DHEAS will be raised. Follow up with an Adrenal CT.

Symptoms include Hirsutism and Acanthosis Nigricans

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13
Q

How would we treat a case of unexplained female infertility?

A

Don’t do ovulation induction

Just do IVF

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14
Q

What can cause Tubal block?

A
  • Chlamydia
  • Tumour
  • Ectopic surgery
  • Sterilization
  • Fibroid
  • Endometriosis
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15
Q

What kind of questions would we want to ask a woman when assessing fertility?

A
  • Duration of infertility
  • Past Fertility
  • Past pregnancies Complciations
  • Past Contraception
  • PMH
  • Menstrual History
  • Sexual History
  • Psychological Assessment
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16
Q

What would you assess on a woman’s exam when thinking of infertility?

A 
Weight, height --> BMI
Fat &Hair Distribution (think hirsutism of androgen excesss)
Galactorrhoea (prolactinoma)
Abdo Exam
Pelvic Exam
17
Q

What baseline tests can be done outside a fertility clinic to assess fertility?

A
  • Rubella immunity?
  • Chlamydia?
  • TSH?
  • Ovulation?
  • Semen Analysis
18
Q

How do we test for ovulation?

A

IF they have regular periods do a Mid-luteal (day 21) phase progesterone

If not do day 1-5 FSH, LH, PRL, TSH & testosterone

19
Q

Once at a fertility clinic we can do futher tests for women, what do these include?

A

Pelvic US looking for Masses, structural abnormalities etc.
Tubal Patency test looking for Tubal Block
Ovulation tests looking for Ovulatory disorders like PCOS

20
Q

How do we test for tubal block?

A

Either with a HyCoSo (Hysterosalpingo-contrast-sonography)

Or Laparoscopy

21
Q

What can we realistically offer an infertile woman?

A

Depends on the cause:

  • Ovulation induction for ovulatory disorders
  • Removal of androgen secreting tumours
  • IVF
22
Q

How does IVF work?

A

Harvest eggs from ovary
Fertilise with sperm in lab
~5days incubation
Implant embryo using transfer catheter

23
Q

ICSI is another form of IVF, how does it work?

A

Injection of a single sperm into mature eggs instead of mixing the two in a lab and allowing for normal fertilisation

24
Q

What is the freezing of eggs known as?

A

Cryopreservation

25
Q

What are some of the common primary ovulatory disorders?

A
  • Craniopharyngioma
  • Low body weight
  • Kallmans syndrome
  • Idiopathic
26
Q

What is Kallmans syndrome

A

Characterised by hypogonadism

Primary ovulatory disorder with Amennorea and anosmia

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