Card Set Information
obs + gynae
How is subfertility defined?
No conception after a year of regular unprotected intercourse.
What are the four baic conditions required for pregnancy?
egg, sperm, egg meeting sperm, implantation.
anovulation is the cause in 30% of subfertility, but in 25%, it is unexplained.
What investigations detect ovulation?
Progesterone at day 21, cervical mucus spinnbarkeit, temperature charts.
What history gives clues to ovulation?
Mucus changes through cycle, PMS around day 14.
What is the commonest cause of anovulation?
What is the aetiology of PCOS?
increased insulin resistance, and LH, breaks down normal feedback mechanisms between the ovary and pituitary.
What aspects of the history suggest PCOS?
obesity, acne, hirsuitsm, oligomenorrhoea or amenorrhoea.
What investigations confirm PCOS?
ultrasound, elevated LH/FSH ratio, elevated testosterone
what are the complications of PCOS?
diabetes, cardiovascular disease, endometrial and breast carcinoma.
Describe the management of PCOS.
the pill improves menstruation if not hoping for pregnancy. Lose weight. Acne management and hirsutism management. For fertility, consider clomiphene (wait list), an anti-oestrogen.
A patient with subfertility shows reduced FSH and LH levels. What might you consider?
Hypothalmic hypogonadism - usually due to low body weight.
A patient with subfertility has hyperprolactinaemia. What might you consider and what is management.
prolactinoma (or PCOS). Use dopamine agonist (bromocriptine).
What are the common causes of anovulation?
PCOS, hypothalmic hypogonadism, hyperprolactinaemia.
In hypothalamic hypogonadism, if weight is normal, how can you stimulate ovulation?
How do you test male fertility?
What are the common causes of abnormal semen analysis?
unknown, smoking, alcohol, drugs, tight trousers, antibodies, varicocoeles.
What is the main reason for fertilization abnormalities?
Tubal damage (also cervical and sexual problems)
What are the main causes of tubal damage?
infection, endometriosis, previous surgery.
What is management for tubal damage?
Sometimes microsurgery (raised ectopic pregnancy rates), IVF is the choice if tubal damage is severe, or if surgery fails.
What are the total investigations you would perform for subfertility?
luteal phase progesterone, mid-cycle pelvic ultrasound, FSH, LH, ostradiol, testosterone, prolatein, TFTs, semen analysis. Then laparoscopy/ MRI.
What general advice would you give for subfertility?
moderate weight, take folic acid.
What are the main causes of secondary amenorrhoea?
Drugs (e.g. Contraceptives), pregnancy, menopause, hypothalmic hypogonadism (low body weight / sport), breastfeeding.