Term
| What is the definition of infertility? |
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Definition
| inability to conceive a pregnancy after 12 months of unprotected intercourse |
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Term
| Wha is the prevalence of infertility among reproductive age couples? |
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Definition
|
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Term
|
Definition
| 35% female, 30% male, 20% combined factors, 15% idiopathic |
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Term
| Waht are teh causes of female infertility? |
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Definition
| MC= anatomic or mechanical (adhesions/endometriosis), 2nd MC= endocrine or menstrual |
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Term
| What are the 2 most common causes of male infertility? |
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Definition
| 1= varicocele, 2= idiopathic (then semen disorders, testicular failure, other, obstruction= cryptorchidism) |
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Term
| What are the risk factors for infertility? |
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Definition
| advanced age, infections, teratogens, past abdominopelvic surgeries |
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Term
| Reduced fertility occurs after age ____. |
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Definition
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Term
| What causes reduced fertility in females after age 36? |
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Definition
| changing ovulation/menses |
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Term
| What causes reduced fertility in males after age 36? |
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Definition
| decreased levels of testosterone |
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Term
| What infections put you at risk for infertility? |
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Definition
| STDs, mycoplasma, male TB |
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Term
| What teratogens are a risk factor for infertility? |
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Definition
| EtOH (alters ovulatory cycle and decreases testosterone), and tobacco and marijuana (alters cervical mucus and decreases sperm motility) |
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Term
| Why is past abdominopelvic surgeries a risk factor for infertility? |
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Definition
| causes adhesions/obstruction |
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Term
| What quesitons should be asked before working up a couple for infertility? |
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Definition
| pregnancy history, sexual history (frequency of intercourse, dysfunctions, contraceptive techniques), menstural history, social history (STDs, EtOH/drugs, occupation= radiation, heavy metal and pesticide exposures, exercise patterns), surgical history, medicines (tetracycline= decreased testosterone, HTNive and chemotx meds) |
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Term
| What is primary amenorrhea? |
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Definition
| never had a menstrual cycle; not considered until more than 14-16 years of age |
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Term
| Is primary or secondary amenorrhea more common? |
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Definition
| secondary is more common (1% of reproductive age women) |
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Term
| What are the common causes of primary amenorrhea? |
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Definition
| 40%=Turner syndrome, 25%= hypothalamus/pituitary, 20%= anatomical defects (mullerian agenesis, imperforate hymen), androgen insensitivity syndrome (5%) |
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Term
| What are the causes of secondary amenorrhea? |
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Definition
| pregnancy, menopause, hypothalamic/pituitary, asherman syndrome, other= celiac sprue, crohns |
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Term
| What are the causes of either primary or secondary amenorrhea? |
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Definition
| pregnancy, androgen secreting tumors, autoimmune disease, chemotherapy/meds, hypo/hyperthyroidism, PCOD, eating disorders, excessive exercise, cushing disease, hyperprolactinemia |
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Term
| What are the general components of the infertility physical exam? |
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Definition
| height/weight/BMI (eating disorders--> hypothalamic dysfunction; obesity--> ovulatory and sperm dysfunction), any dysmorphisms (face, neck, extremities, hair), thyroid exam (hypo and hyperTH signs and symptoms) |
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Term
| What are the components of the GU exam infertility exam? |
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Definition
| secondary sexual development, female= pelvic exam +/- invasive testing; male= inguinal/scrotal exam |
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Term
|
Definition
| development of external genitalia in boys and breast development in girls |
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Term
| Gonadarche is under the influence of... |
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Definition
| pituitary hormones (gonadotropins, e.g. FSH/LH) |
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Term
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Definition
| development of pubic hair, loose association with putberty, under control of adrenal cortical homones (androgens from the zona reticularis) |
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Term
| What are the tanner stages of adrenarche for boys? |
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Definition
1= prepubertal
2= enlargment of scrotum and testes; scrotal skin reddens and changes in texture
3= enlargment of penis (length at first), further growth of testes
4= increased size of penis with growht in breadth and development of glans; testes and scrotom larger; scrotum skin darker
5= adult genitalia |
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Term
| What are the tanner stages of gonadarche for girls? |
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Definition
1= prepubertal
2= breast bud with elevation of breast and papilla; enlargment of areola
3= further enlargment of breast and areola; no separation of their contour
4= areola and papilla form a seoncary mound above level of breast
5= mature stage= projection of papilla only, related to recession of areola |
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Term
| What are the tanner stages of adrenarche? |
|
Definition
1= prepubertal velus hair
2= sparse groth of long slightly pigmented hair at base of penis or along labia
3= darker, coarse and more curled hair, spreading sparsely over junciton of pubes
4= hair adult in type but covering smaller area than in adult; no spread to medial surface of thighs
5= adult in type and quantity with horizontal distribution |
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Term
| What are the types of invasive female GU exams used in an infertility exam? |
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Definition
| transvaginal pelvic U/S, hysterosalpingogram, laparoscopy/hysteroscopy |
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Term
| What is a testicular varicocele? |
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Definition
| dilated and tortuous testicular veins (pampiniform plexus) |
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Term
| 40% of infertile men are infertile due to... |
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Definition
|
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Term
| Where are testicular varicoceles most commonly located? |
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Definition
| left > right but 80% bilateral |
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Term
| How does a varicocele cause infertility? |
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Definition
| increased scrotal temperature or tissue hypoxia |
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Term
| Laboratory work up for infertility in female= |
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Definition
| documentation of ovulation and luteal phase assessment |
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Term
| What is the laboratory w/u for male infertility? |
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Definition
| semen analysis, anti-sperm antibody |
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Term
| What is the laboratory work up for infertility in a couple? |
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Definition
| post coital test, endocrine axis labs in specific situations |
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Term
| At what day of the cycle does ovulation occur? |
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Definition
|
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Term
| What causes the LH surge? |
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Definition
|
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Term
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Definition
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Term
| How long after the LH surge does ovulation occur? |
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Definition
|
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Term
| What days of the cycle is the luteal phase? |
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Definition
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Term
| What happens to the ovaries int eh luteal phase? |
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Definition
| empty ovarian follicle degenerates into corpus luteum which secretes progesterone |
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Term
| Progesterone reaches its peak and its trough during what phase of the menstural cycle? |
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Definition
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Term
| What happens to the uterus during the luteal phase? |
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Definition
| thick endometrium ready for mensturation; "secretory phase" of endometrium |
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Term
| How do you evaluate ovulation and the luteal phase with labs? |
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Definition
| detect LH surge with urine LH, progesterone levels, basal body temperature chart, endometrial biopsy |
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Term
| What progesterone levels indicate a normal ovulation and luteal phase? |
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Definition
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Term
| What happens to the basal body temperature during the menstural cycle? |
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Definition
| rises due to rising progesterone during the luteal phase |
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Term
| What finding on endometrial biopsy indicates that both ovulation and the luteal phase took place? |
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Definition
| secretory glands after day 15 |
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Term
| What is a normal change in BBT for a menstrual cycle? |
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Definition
| rise more than .4 degrees farenheit that stays elevated for more than 10 days and then returns to baseline |
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Term
| What happens to your BBT if you become pregnant? |
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Definition
| increase by .4 degrees stays elevated for more than 3 weeks |
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Term
| How should a semen analysis be collected? |
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Definition
| after 3 days of abstinence, sterile plastic container, room temperature, must be analyzed within 30 minutes |
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Term
| What are the parameters for semen analysis? |
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Definition
| volume, pH, WBCs, concentration, % motile, morphology |
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Term
| What is the normal semen volume? |
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Definition
|
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Term
| What is a normal semen pH? |
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Definition
|
|
Term
| What is a normal WBC count for semen? |
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Definition
|
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Term
| What is a normal semen concentration? |
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Definition
| approx 15 million sperm/mL |
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Term
| What is a normal motility on semen analysis? |
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Definition
| 1/2 should be motile after 1 hour |
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Term
| What is a normal morphology for semen analysis? |
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Definition
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Term
| What is the term for abnormal amounds of WBC in semen? |
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Definition
|
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Term
| What is the term for abnormally low concentration of sperm in semen? |
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Definition
|
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Term
| What is the term for sperm that are not motile? |
|
Definition
|
|
Term
| What is the term for sperm with abnormal morphology? |
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Definition
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Term
| Anti-sperm antibodies causes ___% of male infertility. |
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Definition
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Term
| Agglutination on semen analysis suggests.... |
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Definition
|
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Term
| What are the risk factors for anti-sperm antibodies? |
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Definition
| infection, trauma, or post vasectomy (70%) |
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Term
| IgA anti-sperm antibodies interferes with... |
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Definition
|
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Term
| IgG anti-sperm abs interferes with... |
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Definition
|
|
Term
| Post coital test is also known as the... |
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Definition
|
|
Term
| The post coital test is testing for... |
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Definition
| cervical mucus and sperm interaction |
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Term
| What is the protocal for the post coital test? |
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Definition
| performed within 1-2 days of ovulation and within 12 hours of intercourse, swab cervical mucus, gross and microscopic examination |
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Term
| What do you call a normal PCT? |
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Definition
| positive= normal; negative= abnormal |
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Term
| Normal cervical mucus on PCT= |
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Definition
| >0.5 mL that stretches (max 8 cm at ovulation) and "ferns" |
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|
Term
| What is a normal sperm evaluation on PCT? |
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Definition
|
|
Term
| What is the most common cause of an abnormal or negative PCT? |
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Definition
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Term
| WHen is an endocrine evluation for infertility indicated? |
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Definition
| women with menstrual abnormalities or men with an abnormal semen analysis |
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Term
| What hormones are evaluated in infertility? |
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Definition
| FSH, LH, prolactin, testosterone, estrogen |
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Term
| What is the more common type of endocrine cause of infertility? |
|
Definition
| primary hypogonadism (secondary hypogonadism is less common) |
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Term
| What is primary versus secondary hypogonadism? |
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Definition
| primary hypogonadism is failure at the level of the gonads, secondary is a failure at the level of the hypothalamus pituitary axis |
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Term
| increased FSH/LH with a decreased testosterone/estrogen suggests= |
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Definition
|
|
Term
| low FSH/LH with low testosterone/estrogen suggests= |
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Definition
|
|
Term
| Name some physical dysmorphisms suggestive of turner's. |
|
Definition
| normal pubic and axillary hair, low posterior hairline, little breast development, short stature, short 4th metacarpals |
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Term
| What are the laboratory findings in PCOS? |
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Definition
| increased testosterone, increased LH with decreased FSH (LH:FSH >2:1) |
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Term
| What do polycystic ovaries look like grossly? |
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Definition
| oyster shell ovaries with 3-7 mm cysts |
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Term
| What percent of women have PCOS? |
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Definition
| 5%; 30% of amenorrheic women; 90% of oligomenorrheic women |
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Term
| What are the complications of PCOS? |
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Definition
| infertility, hirsutism, endometrial cancer, obesity (50%), DM (40%) |
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Term
| What is the probability of conception for fertile couples in 1 cycle? 3 cycles? 6 cycles? 12 cycles? 2 years? |
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Definition
| 1 cycle= 20%; 2=57%; 3=72%; 12= 85%; 2 years= 93% |
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