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41 Cards in this Set
- Front
- Back
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monthly conception rate
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25% (1/4 couples trying per month)
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cause of hypofertile?
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male factor
endometrosis |
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cause of sterility?
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premature ovarian failure
bilateral tubal occlusion azoospermia |
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couple can't conceive after 1 year of sexual intercourse without using any type of contraception
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Primary infertility
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couple can't conceive after 6 months if the female partner is over the age of 35
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Primary infertility
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female has conceived at least once before (even if it had a miscarriage or termination)
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Secondary Infertility
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What is female fertility mostly based on?
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age - ticking clock phenomenon
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most common cause of infertility
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male factor (40%)
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things to consider in the evaluation
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1. male factor/sperm function
2. ovarian function 3. tubal function/pelvic factor 4. uterine/endometrial factor 5. cervical function |
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female history
non-specific abdominal pain or cramping that coincides with ovulation condition? |
Mittelschmerz pain
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infertile female pt w/ pelvic pain
possible cause? |
endometriosis
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inferile female pt
potential past pelvic infections? |
gonorrhea
chlamydia PID endometriosis |
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infertile female pt
possible surgical cause? |
pelvic - ovarian cyst, endometriosis, C-section, tuboplasty
non-pelvic - appendix, bowel surgery |
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Uterine history factors
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1. Menstraul flow - length and amount
2. Dilation and Curettage 3. Recurrent miscarriage 4. IUD use 5. Prior pregnancy |
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Cervica factors
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1. post-coital test (PCT) - mid-cycle mucus quality
2. hx of abnormal pap smear w/ cryosurgery, laser or LEEP of cervix |
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Male hx factors
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1. viral orchitis (mumps)
2. epididymitis 3. STDs 4. Bladder infections 5. Illness w/ fever w/in last 70-90 days |
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Male factors
surgical |
1. hernia repair
2. testicular torsion 3. hot tub use 4. anabolic steroids 5. chronic marijuana, cigs |
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most common cause of acquired testicular failure in a subfertile male
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viral orchitis (mumps)
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most reliable indicator of ovarian function
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regular menstraul cycles
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What does a biphasic basal body temp indicate?
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pt is ovulating
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what are some very often used methods of testing ovarian function
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mid-luteal phase progesterone
TSH serum prolactin |
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how do you test tubal/pelvic factor?
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HSG
Laparoscopy |
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How do you test utertine function
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HSG, or sonogram
Late luteal phase endometrial biopsy (gold standard) |
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Late luteal phase endometrial biopsy vs. serum progesterone
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Late luteal phase endometrial biopsy is gold standard
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how do you test cervical function?
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post-coital test
pap smear cultures for STDs |
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how do you test sperm function?
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semen analysis (gold standard)
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basic initial workup for infertile couple
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1. semen analysis
2. ovulation assessment: BBT, LH level, mid-luteal progesterone 3. TSH, PRL 4. HSG 5. female age >35: TSH, estradiol on cycle day #3 |
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how do you manage ovulatory dysfunction
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1. Clomiphene
2. Laparoscopy 4. GnRH injection 5. IVF |
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how do you manage ovulatory dysfunction
if hypothalamic or female age >35 |
1. GnRH injection
2. IVF |
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how do you manage ovulatory dysfunction
if hyperprolactinemia |
Bromocriptine or Cabergoline
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how do you manage ovulatory dysfunction
if hypothyroidism |
Levothyroxine supplementation
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how do you manage ovulatory dysfunction
if hypERthyroidism |
radioactive iodine (thyroid ablation)
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Abnormal HSG
submucous fibroid, polyp or adhesion dx? tx? |
Uterine filling defect
Hysteroscopy |
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Abnormal HSG
unicornuate/bicornuate or septate uterus dx? |
Uterine malfunction
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Tubal occlusion
dx if: proximal distal (fimbrial) and hydrosalpinx present |
proximal - hysteroscopy/laparoscopy
distal - laparoscopy over IVF (or both) |
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endometriosis/adhesions
tx? |
Laparoscopy, eventually IVF
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Large (>4 cm) uterine fibroids in close proximity to uterine cavity
tx? |
uterine myomectomy
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cervical factor
tx? |
1. treat any positive culture
2. treat abnormal pap smears FIRST (prior to infertility treatment) 3. abnormal PCT - consider IUI |
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abnormal male factor
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1. repeat semen analysis
2. refer to urologist 3. IUI x 4 cycles 4. IVF x 3 |
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couple w/ cystic fibrosis is worried
what would you recommend? |
PGD (preimplantation genetic diagnosis)
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best chance for conception
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1. anovulatory pt (80% success)
2. female <38 3. have been trying <3 yrs (80% success) 4. male factor infertility --> can use IVF or donor sperm |
