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Flashcards in Infertility Deck (44)
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1

Define Infertility

Failure to conceive after 1 year of unprotected intercourse in women less than 35 years of age and after 6 months in women 35+

2

Lifestyle Factors Associated with Increased Risk of Infertility

Environmental & occupational
Toxic effects of tobacco, marijuana
Excessive exercise
Inadequate diet (extreme weight loss or gain)
Advanced age

3

Factors Associated with Infertility

Male factor
Ovulatory dysfunction
Tubal damage
Endometriosis
Coital problems
Cervical factor
Unexplained

4

Female Factors Associated with Infertility

Cervical
Uterine
Ovarian
Tubal
Peritoneal

5

Cervical Factors Associated with Infertility

Stenosis
Abnormality of the mucus-sperm interactions

6

Uterine Factor Associated with Infertility

Congenital or acquired defects may affect endometrium or myometrium

7

Ovarian Factor Associated with Infertility

Ovulatory dysfunction

8

Tubal Factors Associated with Infertility

Abnormalities or damage to fallopian tube
Congenital or acquired

9

Peritoneal Factors Associated with Infertility

Anatomic defects
Physiologic dysfunctions

10

Types of Physiologic Dysfunctions Associated with Infertility

Infection
Adhesions
Adnexal masses
Endometriosis

11

Male Factors Associated with Infertility

Pre-testicular
Testicular
Post-testicular

12

Pre-testicular Factor Associated with Infertility

Congenital or acquired diseases of the hypothalamus, pituitary, or peripheral organs that alter the hypothalamic pituitary axis
Ex: prolactinoma

13

Testicular Factors Associated with Infertility

Genetic: Klinefelter
Non-genetic: marijuana, radiation, varicoceles

14

Post-testicular Factors Associated with Infertility

Congenital or acquired factors that disrupt normal transport of sperm through the ductal system

15

Examples of Post-Testicular Factors Associated with Infertility

CF
Chlamydia
Gonorrhea
Trauma
Surgery
Lack of vas deferent on one side

16

Evaluation of Infertility

Complete eval performed according to the woman's menstrual cycle

17

History in the Evaluation of Infertility

Copy of previous medical records
Complete medical history questionnaire
Details regarding type of infertility
Hx of previous pregnancies & outcomes
Hx of previous infertility eval/treatment
Female menstrual history, frequency & patterns since menarche
Male medical history of any previous semen analysis
Couple's history of STDs
Couple's current medical treatment, reason, & history of allergies
Complete ROS to identify endocrine or immunologic reasons

18

Male Medical History in Evaluation for Infertility

Previous semen analysis results
H/O impotence
Premature ejaculation
Change in libido
Trauma
Other relationships with children

19

Female Medical History in Evaluation of Infertility

Previous femal pelvic surgery
PID
PCOS
Appendicitis
IUD use
Abdominal adhesions
Ectopic pregnancy history
Stress
Depression
Weight changes

20

Examination of Female Patients for Infertility

Obtain records of BP, pulse, & temp
Calculate BMI
Perform eye exam for exophthalmos
Look for Turner's syndrome
Breast exam
Abdominal Exam
Complete female pelvic exam

21

Signs/Symptoms of Turner's Syndrome

Epicanthus
Low setting ears
Webbed neck

22

Examination of Male Patients for Infertility

Urologist will examine if semen analysis is abnormal
Full GU exam
Testicular size
Varicose veins around testicle
Abdominal exam

23

Work Up of Infertility

Organized & Thorough
Diagnostics from simplest to complex & invasive
Educate couple it may take 2+ menstrual cycles to determine a cause

24

Male Work Up of Infertility

Semen analysis
Free & total testosterone levels
Obtain prolactin level in men with low testosterone (Prolactinoma)
Genetic testing with azoospermia (Klinefelters)
Consult to Urology

25

Semen Analysis

Sperm concentration
Motility
Morphology
Viability

26

Female Work Up for Infertility

Cervical factors: stenosis
Uterine factors
Endometrial factors
Tubal factors
Peritoneal factors
Ovarian factors

27

Uterine Factors for Infertility

Absence of uterus
Vaginal septum
Fibroids

28

Studies for Diagnosis Uterine Factors of Infertility

Hysterosalmpingogram (HSG)
Pelvic ultrasound
Saline infusion sonography (SIS)
Hysteroscopy
Endometrial biopsy

29

Hysterosalpingogram

Evaluate endometrial cavity
Performed during early follicular phase

30

Hysterosalpingogram Procedure

Cervix prepped with Betadine
Breakaway speculum used
Single tooth tenaculum used for traction of uterus
Balloon HSG cath or metal cannula with plastic acorn tip