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GYN Infertility
| Question | Answer |
|---|---|
| Infertility definition | failure to acheive a successful pregnancy after 12 months or more of regular unprotected intercourse. |
| Evaluate infertility earlier when | over 35 yo, irregular periods suggesting anovulation, hx of endometriosis or tubal dz, known male factor. |
| Physical Exam components | Thyroid, Galactorrhea, Uterine and adnexal size and tenderness |
| How to evaluate eggs | ovulation, ovarian reserve |
| How to evaluate Tubes | HSG (hystosalpingogram - test to see if tubes are open), Laparoscopy |
| How to evaluate Sperm | Semen analysis, Urology evaluation |
| Urinary ovulation kit measures | LH |
| How is ovulation measured? | Urinary LH ovulation predictor kit, US, Endometrial Biopsy (antiquated; painful and not very informative) |
| Most women with anovulation are classified as | WHO II: E, normal FSH, normal Prl |
| Breasts are the result of exposure to which type of estrogen? | E2 |
| Meds that can alter prolactin levels and cause irregular periods | neuroleptics, SSRIs, Anti-HTN, Metoclopramide, H-2 Blockers (Cimetidine). MRI to r/o brain lesion |
| Prolactin negative feedback | Prolactin can feedback on hypothalamus and tell it not to do it’s job of stimulating pituitary and hence the ovaries |
| Anovulation with high FSH indicates | Ovarian Failure |
| What type of amenorrhea do super athletes get? | Hypothalmic amenorrhea |
| What egg characteristics change with age? | Egg quantity, egg quality, egg recruitment (follicle dynamics) |
| Egg quantity over time | At birth: 1 million follicles, At Menarche: 400,000, Ovulated: 400, Remaining at menopause: 1000. |
| How to evaluate Ovarian Reserve | Biomarkers: Day 3 FSH, Estradiol (classic tests), Inhibin (Clomid Challenge Test), Anti-mullerian hormone. Ultrasound: Antral follicle count, Ovarian Volume |
| Day 3 FSH, E2 probing the pituitary | As egg number decreasesLess feedback from ovaryFSH risesMany false normals |
| How does FSH change with age? | Increases. Delivery rates decline with increasing age and FSH levels |
| ___ predicts ovarian response to fertility drugs | Antimullerian Hormone (AMH) |
| Antral follicle count change with age | decreases |
| ___ evaluates tubal patency | hysterosalpingogram |
| HSG shows | cavity of uterus; if something is wrong, you can detect it with a hysterosalpingogram |
| When is a laparoscopy indicated | Abnormalities on hysterosalpingogram, pelvic pain (high suspicion for endometriosis) |
| Upward transport in Female reproductive tract | Rapid uptake 2 min, Tubal transport only in follicular phase |
| Cervical transport | Essential and we do not have a good test for this |
| Relationship of cervical mucus and sperm transport | Sperm penetration increases wtih increasing hydration. Increase in hydration precedes LH surge |
| Predictive power of pregnancy with mucus vs. time to ovulation | Mucus is a stronger predictor. Unfortunately, we don't have a test for it |
| Post Coital Mucus test | RCT showed no pregnancy benefit. |
| Lubricants and sperm motility | Avoid if possible. Canola oil showed no difference in sperm motility, but KY jelly, olive oil and saliva all decreased sperm motion. |
| Where are sperm made? | Seminiferous tubules - spermatogenesis. |
| ___ stimulates testosterone synthesis/secretion | LH. FSH increases the number of LH receptors |
| How many days does spermatogenesis take? | 70 |
| semen analysis procedure | 2-5 days abstinence prior, send to lab within 1 hour of collection, 2-3 samples before diagnosis is secure |
| Low motility of sperm | Asthenospermia |
| Low morphology of sperm | Teratospermia |
| No sperm in ejaculate | Azospermia |
| Low sperm count | oligospermia |
| WBCs in ejaculate | should have a lot |
| Sperm Antibodies | Sperm antigenic, Serum antibodies not associated with infertility, Sperm antibodies from testicular trauma, infection or surgery. Agglutination treated with sperm wash, IUI, or IVF |
| Hx for sperm evaluation | Injury, surgery, mumps, heat decreases spermatogenesis, Marijuana and alcohol depress count/testosterone, cocaine decreases spermatogenesis |
| Genetic Evaluation of male | Y microdeletions oligospermia, Klinefelter's (XXY) 1/500 azospermia, DAZ, Bilateral absence of vase deferens in 1-2% |
| hypogonadotropic hypogonadism Kallman's | Pituitary isn't stimulating gonad to make sperm, but still be stimulated if given shots |
| Hypergonadotropic hypogonadism | Testicle failed. Elevated LH= lydig cell dysfunction. Elevated FSH= spermatogenic dsyfunction |
| Retrograde Ejaculation | Abnormal function of internal sphincter of urethra. Associated with prostatectomy, LND, spinal cord injury, diabetic neuropathy, meds (alpha blockers) |
| IUI | Intrauterine insemination |
| WBC without infection | vit E to decrease ROS |
| Controlled ovarian stimulation with gonadotropins | Allows recruitment of more than one dominant follicle. Can only recruit what the ovary brings that cycle. FSH normally shuts window once one egg has triumphed; this keeps FSH door open longer so more eggs can be ovulated |
Created by:
ltm12