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