Infertility Flashcards by Grace Dewling

Infertility definition

Failure to achieve successful pregnancy after >12 months of regular unprotected sexual intercourse

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What should women be taking prior to conception

Women should take about 800 mcg of folic acid

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What factors affect fertility

Tobacco, ETOH, drugs

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What affects sperm production

Tight underwear, sauna or a hot tub can affect sperm potency

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Infertility mc causes female

Ovulatory dysfunction such as PCOS, most commonly
Endometriosis
diminished ovarian reserve

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Infertility mc cause in males

Primary testicular failure, 30-40%
Spermatogenesis
Genetic abnormalities

Varicocele 12-27%

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Infertility physical exam

Performed on both partners
Assess thyroid, skin, genital exam, weight bmi

Males assess for Varicocele

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Infertility eval done if >__ months of active unprotected sex or 6 months if female is >35

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Assessment for infertile (4 key areas)

Ovulatory function
Ovarian reserve
Uterine or tubal anat9my
Sperm analysis

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High >6 anti mullerian hormone is suggestive of what?

Anti mullerian hormone looks at fertility level

Suggest PCOS, assess ovarian reserve

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Additional test for PCOS

Assess androgen
LH, fsh
Metabolic profile

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Added tests for infertility include

Thyroid, Hyperprolactinemia, and genetic or autoimmune causes

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First line imaging for women who u may suspect abnormal anatomical pelvic pathology

Transvaginal ultrasound would be the first line option

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Male eval infertility involved one or more _____ analysis

Semen

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Men semen analysis abstain from sex ____ days prior, and
need to be collected within __ hour
and __ samples __ week apart

2-5 days prior, collected in 1 hour, snd is
2 sample 1 week apart

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Semen analysis results less than 10 million sperm what to check

Repeat 4-6 weeks and then should check a FSH AND test

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Men with extremely low sperm <5 check ______

Karyotype, could be klinefelter disease

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Men with low ejaculate volume assess what <1.5

Varicocele

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Fertility pills (2)

Clomiphene citrate
Letrozole

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Fertility injection

Fsh
Gonadotropic releasing hormone
Human menopausal gonadotropin

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Infertility tx complication

Ovarian hyper stimulation syndrome, can cause organ failure
Thromboembolic event
Procedure risk, bleeding, infection, local injury
Multiple gestation pregnancies

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Contraception is what

Intervention to decrease chances of pregnancy after sexual intercourse

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Behavioral contraception two method

Coitus interuptus, pull out method, withdraw penis, prior to ejaculation

Fertility awareness based method, identifying fertile days, of the menstrual cycle,and measuring basal body temp

Best for non hormonal option

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Barrier method for contraceptive

Male condom
Female condom
Diaphragm
Cervical cap
Contraceptive sponge
Spermicide

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What barrier methods require being fitted by provider

Diaphragm and cap Both used with spermicide,

Diaphragm has a risk for _____ uti

Recurrent uti

Sponge cap and diaphragm must leave in for __ hours after sex

Spermicide need to wait atleast __mins for sex after application

Only birth control which protects against STI is

Condoms

Reasons to use bc

To prevent pregnancy Regulate menstruation PCOS tx Peri menopausal

Contraindication bc

History of VTE Stroke, or ischemia, Uncontrolled HTN Migraine with aura Decompensated cirrhosis or liver disease Diabetic with complication >35 snd smoke >15 cigs

Birth control pills combine estradiol and progestin’s, Estrogen inhibit ___(stop ovulation)

FSH Progestin prevent LH SURGE

Patient who is a smoker over 35 and hx DVT can take what birth control pill

Can take mini pill, progestin no estrogen

Mini pill, which is progestin and no estrogen is good for what kind of pt

Smoker who is over 35 years old HTN PT DVT Thicken mucous and thins endometrium does not affect ovulation

Two alternate deliveries of birth control, include

Ortho evra and the nuva ring

Ortho evra not to be used in women BMI >__

Emergency contraception true or false is effective is women is pregnant already

False

Emergency contraception 2 options

2 oral progesterone, or a copper iud

Paraguad IUD should be used within __ days to prevent contraceptive emergency

Plan b emergency contraception must be used within ___ hours after unprotected sex

Ullipristql, Ella has a longer window then plan b and can be used up to ___ hours

120

IM INJECTION GIVEN EVERY 12 weeks

Depo provera Window is 10-14 weeks

Depo provera must supplement with ____ and ____ due to the risk for bone density loss

Calcium and vit d

Depo provera pro

Only progesterone so good for pt unable to use standard estrogen birth control Less risk to forget taking the dose

Depo provera downside

Bone density loss, not to be used longer than 3-5 years High risk for weight gain, Require office visit

What birth control, inhibit ovulation and inserted into the inner upper arm, in office

Nexplanon

Nexplanon is active for ___ years

Nexplanon requires provider certification true or false

True

Downside to Nexplanon

In office procedure Can lead to Trauma or scarring

Nexplanon is inserted _____ cm proximal to medial epicondyle

8-10

Nexplanon contraindicated in pts who has

Migraine with aura Breast cancer Decompensated cirrhosis, or liver cancer CVA

IUD progesterone options include

Mirena, up to 8 years Kyleena, up to 5 years Skyla, active up to 3 years

Most effective prevention secondary to sterilization is

IUD progesterone mirena, Skyla, kyleena

Pros to iud, progesterone

Amennorhea, Good for a women who has contradictatjon to oral contraceptive pills Long acting and effective pregnancy prevention

Cons to iud progesterone (mirena, Skyla)

Require offic procedure, Discomfort Risk for bleeding and infection or uterine perforation Potential for lost strings

IUD progesterone contraindication

Active pelvic infection Breast cancer Liver disease Fibroid uterus, or if uterus >9 cm, or <6 cm Liver disease

Paragard has hormones true or false, ?

False , no hormones with paragard

Paragard, _____ interferes with sperm transport

Copper

Paragard can stay inserted for

10 years

Paragard affects menses or ovulation?

No Paragard is hormone free, therefore, it does not affect menses or ovulation at all.

Paragard cannot insert until __ weeks post partum

Cons to paragard

Office procedure required Can cause some bleed, infection or perforation of uterus

Paragard contraindications includes

Active pelvic infection Unexplained vaginal bleed Active gyn cancer treatment

For males permanent contraception is

Vasectomy, excise vas deferen

For males after vasectomy what to assess

Semen analysis, assure effectiveness, can take up to 3 months, or 20 ejaculatipns Effective if sperm is <100,000

Infertility Flashcards

(65 cards)