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3MB Reproduction > Infertility > Flashcards

Infertility Flashcards

1
Q

List some factors that are increasing the demand for assisted conception therapy (ACT)

A

Increasing parental age
Increasing chlamydia
Male factor infertility
Improved success rates of ACT

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2
Q

List the main indications for ACT

A 
Male factors
Unexplained infertility
Endometriosis
Tubal disease
Ovulatory disorder
Single parents/same sex couples
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3
Q

At what age does fertility start to decrease?

A

27

Significantly so at 37

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4
Q

What should females limit their alcohol limit to per week to improve fertility?

A

4 units a week

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5
Q

What is the optimal weight for males + females to improve fertility?

A

BMI 19-29

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6
Q

What medical interventions should be assessed before ACT to improve fertility?

A

Folic acid
Check rubella immunity
Cervical smear
Blood-borne viruses screen

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7
Q

Which drug class in particular can cause male infertility/azoospermia?

A

Steroids (if abused)

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8
Q

How long should a female wait before trying to conceive after being vaccinated against rubella?

A

3 months

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9
Q

List all the assisted conception treatments available

A 
Donor insemination
Intra-uterine insemination (IUI)
In vitro fertilisation (IVF)
Intra-cytoplasmic sperm injection (ICSI)
Surrogacy
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10
Q

What does intra-uterine insemination involve?

A

Sperm are injected into the uterine cavity around the time of ovulation

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11
Q

What does in vitro fertilisation involve?

A

Sperm and egg fertilise outside body and implanted into uterus

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12
Q

How is the normal menstrual cycle down-regulated in preparation for IVF?

A

Synthetic GnRH agonist administered as spray/injection

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13
Q

How is the ovary stimulated to cause follicular development?

A

Synthetic GH injection

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14
Q

What are the risks to GH injection?

A

Allergy

Ovarian hyperstimulation syndrome

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15
Q

How long must a male be abstinent before providing a sperm sample?

A

72 hours

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16
Q

What does intra-cytoplasmic sperm injection involve?

A

Injecting sperm into egg outside the body (i.e. no fertilisation)

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17
Q

What determines our gender?

A

Chromosomes (XY or XX)
Sex hormones secreted
External + internal genitalia
Psychological factor

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18
Q

Which chromosome has the sex-defining region?

A

Y-chromosome

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19
Q

Which 2 hormones/factors contribute to the development of the internal genital tract in the male?

A

Testosterone

Mullerian inhibiting factor

20
Q

There are 2 primitive genital tracts: Wolffian and Mullerian ducts. Which duct contributes to male and female genital tracts respectively?

A 
Males = Wolffian
Females = Mullerian
21
Q

Without stimulation by testosterone + Mullerian inhibiting factor, what develops in the male?

A

Internal genital tract resembling that of a female

22
Q

The testes develop in the abdominal cavity but descend into the scrotal sac before birth. Why?

A

Lower temperature outside the body facilitates spermatogenesis

23
Q

What is cryptorchidism?

A

Undescended testes, resulting in reduced sperm count and increased risk of testicular cancer

24
Q

What does testicular descent depend on?

A

Androgenic drive

25
Q

Where does spermatogenesis occur?

A

Seminiferous tubules

26
Q

Where is testosterone secreted from?

A

Leydig cells

27
Q

List the function of Sertoli cells

A 
Form blood-testis barrier (protection)
Provide nutrients for developing cells
Phagocytosis
Secrete seminiferous tubule fluid
Secrete androgen-binding globulin
Regulate FSH levels through inhibin
28
Q

Where does LH act in the male?

A

Leydig cells - regulate testosterone levels

29
Q

Where does FSH act in males?

A

Sertoli cells - enhances spermatogenesis

30
Q

What are the 3 main categories of causes of male infertility?

A

Idiopathic (most common cause)
Obstructive
Non-obstructive

31
Q

List some obstructive causes of male infertility

A

Cystic fibrosis (vas deferens defect)
Vasectomy
Infection

32
Q

List some non-obstructive causes of male infertility

A 
Cryptorchidism
Infection
Radiation (chemo/radiotherapy)
Testicular tumour
Genetic: Klinefelter's
Semen structure abnormality
Systemic/endocrine disorders
33
Q

List some pituitary causes of male infertility

A

Tumours
Acromegaly
Cushing’s disease
Hyperprolactinaemia

34
Q

List some hypothalamic causes of male infertility

A

Tumour
Increased exercise
Kallmann’s syndrome
Anorexia

35
Q

Which drug when abused is notorious for causing male infertility?

A

Steroids

36
Q

What would be assessed on genital examination in a male with infertility?

A 
Testicular volume (normal = 12-25ml)
Presence of vas deferens + epidydimis
Penis
Urethral orifice
Presence of swellings/varicocele
37
Q

What 5 domains are assessed on semen analysis?

A 
Volume
Density (number of sperm)
Motility (how many are moving)
Progression (how well they move)
Morphology
38
Q

What extrinsic factors may cause abnormality in semen analysis?

A 
Completeness of sample
Period of abstinence from sex
Conditions during transport
Time delay
Health of the man
39
Q

How would testicular volume, secondary sexual characteristics, endocrine hormones and structure of vas deferens be affected in obstructive male infertility?

A

All normal

Vas deferens may be absent

40
Q

How would testicular volume, secondary sexual characteristics, endocrine hormones and structure of vas deferens be affected in non-obstructive male infertility?

A

Low testicular volume
Reduced secondary sexual characteristics
High endocrine hormones
Vas deferens present

41
Q

List some lifestyle improvements that can help male infertility

A 
Frequent sex, 2-3x a week
Avoid lubricants (toxic to sperm)
Less than 4 units of alcohol a week
Stop smoking
BMI less than 30
Avoid tight underwear, saunas/hot baths
42
Q

When is ICSI indicated over IUI?

A

IUI - low sperm count

ICSI - very low sperm count

43
Q

What is the success (pregnancy) rate of IUI and ICSI?

A 
IUI = 15%
ICSI = 30%
44
Q

When is surgical sperm aspiration indicated?

A

Azoospermia (very low sperm count)

45
Q

What is the success (pregnancy) rate of surgical sperm aspiration?

A

95% in obstructive

50% in non-obstructive

46
Q

If IUI, ICSI and sperm aspiration fail, what is the next option?

A

Donor sperm

3MB Reproduction (32 decks)

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