HD2 > Fertility > Flashcards

Fertility Flashcards

(66 cards)

Study These Flashcards
1
Q

Define infertility

A

Disease of the reproductive system

Failure to achieve clinical pregnancy within 12 months of unprotected sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define primary infertility

A

Woman unable to ever bear a child as unable to become pregnant or carry a pregnancy
- miscarriages, ectopic, abortions and stillborn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define secondary infertility

A

Unable to bear/ability to carry a child following previous pregnancy/having ability to carry pregnancy to live birth before

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How common is infertility?

A

1 in 6 couples in UK experience some form of it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the causes of infertility and how common are they?

A
  • male factors (30%)
  • unexplained fertility (25%)
  • ovulatory disorders (20%)
  • tubal damage (20%)
  • uterine/peritoneal disorders (10%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do the testes develop?

A

On posterior wall

  • descends through inguinal canal
  • into anterior abdomen wall
  • into scrotum
  • carries vessels, lymphatic nerves, ducts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the testes composed of?

A

Semniferous tubules

interstitial tissue surrounding tunica albuginea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the tunica vaginalis?

A

Sides and anterior aspects of testes covered by closed sac of peritoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the epididymis?

A

SIngle, long coiled lying alongside testes

  • efferent ductules (head)
  • true epididymis (body/tail continuous with vas deferens)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the vas deferens?

A

Long muscular duct

Transport spermatozoa from tail of epididymis to ejaculatory duct in prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does the spermatic cord contain?

A 
Vas deferens
testicular artery
Genital branch of genitofemoral nerve
Pampiniform plexus
Lymphatic vessels
Tunica Vaginalis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where does the spermatic cord run?

A

Through inguinal canal

Surrounded by fascia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the main blood supply to the male reproductive system?

A

Abdominal artery branches forming gonadal testicular artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the venous drainage of the right testicle?

A

IVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the venous drainage of the left testicle?

A

Left renal vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the pampiniform plexus?

A

Network of small veins found in human spermatic cord

  • surrounds artery
  • cold as exits scrotum receiving heat from artery as travels back to abdomen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the 3 phases of the ovarian cycle and how long are they?

A 
Follicular Phase (1-10)
Ovulatory Phase (11-14)
Luteal Phase (15-18)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What happens during the follicular phase?

A
  • 5-12 primordial follicles stimulated each month
  • 1 grows and matures
  • GnRH secreted from hypothalamus stimulating anterior pituitary to secrete LH and FSH
  • stimulates follicles to grow
  • mature follicle secretes oestrogen
  • inhibits LH and FSH secretion by anterior pituitary (negative feedback)
  • stimulates endometrium growth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What happens during the ovulatory phase?

A

Negative feedback temporary

  • oestrogen stimulates HPA
  • LH and FSH burst
  • completion of meiosis I and onset of meiosis II in oocyte
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What happens during the luteal phase?

A

Granulosa cells of mature follicle divide forming corpus luteum

  • secretes progesterone and oestrogen
  • prepares uterine endometrium for implantation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the 3 phases of the menstrual cycle and how long are they?

A
  • menstrual phase (day 1-5)
  • proliferative phase (6-14)
  • secretory phase (15-28)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What happens in the menstrual phase?

A

Withdrawal of steroid support (oestrogen and progesterone) = endometrium collapse

  • endometrium shed with blood from rupture arteries
  • 50-150ml blood loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What happens in the proliferative phase?

A

Oestrogen from mature follicle stimulates thickening of endometrium

  • glands/spinal arteries form
  • oestrogen causes progesterone receptor growth on endometrial cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What happens in the secretory phase?

A

Progesterone from corpus luteum acts on endometrium = gland enlargement

  • glands secrete mucus and glycogen in preparation for implantation of fertilised oocyte
  • no fertilisation = corpus luteum degenerates = corpus albicans and progesterone levels fall
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the general conception advice?
- intercourse throughout the cycle - no smoking, alcohol - reduce weight/stress/drugs - take folic acid (400mg)
26
What is COCP?
Trans acid, combined oral contraceptive pill
27
What are LARCs?
Ling acting reversible contraceptives
28
What is Gn therapy?
Gonadotrophins
29
What are the types of ovulatory causes of infertility?
1) Hypopituitary failure (anorexia) - increase weight, decrease exercise, Pulsatile GnRH 2) Hypopituitary Dsyfunction (PCOS, hyperprolactinaemia) - bromocriptine as dopamine agonist which regulates prolactin levels) 3) Ovarian failure (persistent raised FSH) - donor eggs, alternative parenting
30
What is the diagnostic criteria for polycystic ovarian syndrome? (PCOS)
- clinical hyperandrogenaemia - oligomenorrhoea - polycystic ovaries on ultrasound - menstrual disturbance, acne - raised LH with normal FSH, raised testosterone
31
What is the first line management of polycystic ovarian syndrome?
Clomiphene or metformin
32
What is the second line management for polycystic ovarian syndrome?
- combined clomiphene and metformin, lacroscopic ovarian drilling and Gn theraphy
33
What is important to exclude when diagnosing polycystic ovarian syndrome?
Thyroid dysfunction Congenital Adrenal Hyperplasia Androgen secreting tumours
34
What is an example of an ovulatory cause of infertility?
PCOS
35
What are examples of tubal and uterine causes of infertility?
Pelvic Inflammatory Disease Endometriosis Fibroids
36
What is pelvic inflammatory disease?
Infection of female upper genital tract
37
What are the symptoms of pelvic inflammatory disease?
Asymptomatic Pelvic gain, dyspareunia, fever - investigate with FBC and raised ESR
38
What is dyspareunia?
Painful sexual intercourse
39
What causes pelvic inflammatory disease?
Bacteria and STIs | chlamydia and gonorrhoea
40
How is pelvic inflammatory disease managed?
Antibiotics, rest, abstinence
41
What is endometriosis?
Presence of tissue histologically like endometrium outside uterine cavity
42
What are the symptoms of endometriosis?
Pain Dysmenorrhoea (painful menstruation) Menorrhagia Dyspareunia
43
How is endometriosis managed?
NSAIDs COCOP GnRH agonists Surgery
44
What are fibroids?
Benign tumours of SM of myometrium (uterine leiomyoma) | - heavy, regular periods
45
How are fibroids treated?
COCP LARCs Surgical
46
What are the male factors of infertility?
Testicular (infection, cancer, surgical, congenital, trauma) Azoospermia (absence of motile sperm) Reversal of vasectomy Ejaculatory problems (retrograde and premature) Hypogonadism
47
What is advised when there is unexplained fertility?
Do not offer clomiphene as no increased chance of pregnancy/live birth - continue having regular unprotected intercourse - IV after 2 years
48
Which drugs for women lead to infertility?
- long term NSAID - chemotherapy - neuroleptics - spironolactone - Depo-Provera
49
What is Depo-Provera?
Type of birth control injection | Delays fertility by around 6-12 months until return
50
What drugs for men lead to infertility?
Anabolic steroids | Chemotherapy
51
What drugs for men and women lead to infertility?
marijuana | cocaine
52
What are the NCIE guidelines when referring to infertility services?
- initial assessment: enquire lifestyle/sexual history | - only earlier referral is woman over 36 and known clinical cause of infertility/predisposition
53
What primary care investigations are done for infertility?
``` Full sexual/contraception/fertility history PCOS screen FBC (fibroids) Vitamin D HbA1c Viral screen rubella, HIV, hepatitis ```
54
What secondary care investigations are done for infertility?
Assess ovulatory function (blood tests, ovarian reserve testing) Assess tubal function Assess uterine function (laparoscopy)
55
How is a PCOS screen done?
``` day 21 progesterone LH FSH Serum testosterone glucose ```
56
What is ovarian reserve testing?
how receptive ovaries are to Gn stimulation
57
How is IUI done?
Intrauterine Insemination - sperm separated in lab - remove slower speed sperm before partner is inseminated - insemination day 12-16 - ultrasound if ovarian stimulating drugs used
58
Who is IUI offered to?
- people unable to have intercourse - required specific consideration - same sex relationships
59
When is IUI tried?
12 cycles before IVF
60
What are the methods of assisted contraception?
Intrauterine Insemination In-vitro fertilisation Intracytoplasmic Sperm Injection
61
Who is IVF offered to?
- women under 40 who have not conceived after 2 years of unprotected intercourse = 3 cycles - women 40-42 if never had IVF/6 or more IUI cycles/no evidence of low ovarian reserve = 1 cycle
62
What is ovarian hyper stimulation syndrome?
Consequence of drugs used to stimulate ovarian function
63
What is intracytoplasmic sperm injection? (ICSI)
Single sperm injected directly into egg
64
Who is ICSI offered to?
Intracytoplasmic sperm injection - severe deficits in semen quality - azoospermia - IVF failure
65
How is ICSI compared to IVF?
Improves fertilisation rates more | Pregnancy rate is not better
66
What are the long term safety issues related to assisted reproduction?
Ovarian induction and ovarian stimulation (no direct associations between treatment/invasive cancer) IVF - small increased risk of borderline ovarian tumours
HD2
flashcards
Decks in class (22)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions