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50 Cards in this Set

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  • Back
Around what age does fertility peak at for women?
20-24
Does fertility decline as a women ages?
Yes
How has the mean age for first live birth changed from 1970 to 2000?
Increased (women are giving birth later)
For each year of attempted conception without success, the likelihood of future success decreases by how much?
20%
What constitutes the greatest eitological contributor to infertility?
Male factor
TRUE/FALSE Although fertilit treatments decrease the time to conception, they may hinder gamete quality?
FALSE; no effect on gamete quality
What does the "male factor" refer to in a couple's inability to concieve?
Abnormal production of semen, either in quantity or quality
With a normal ejaculate, about how many sperm (out of 20 million) actually reach the distal fallopian tube?
50
What are the three categories of Sub-Normal eitiologies?
Pre-testicular (2% of cases) , Testicular (35%), and Post-testicular (18-40%)
What do you want to check if you suspect a pre-testicular eitiology for infertility?
The brain (kallman syndrome, sarcoidosis, hemochromatosis, prolactinemia, autoimmune hypophysitis)
What do you want to check if you suspect testicular eitiology of infertility?
History (meds, exposures, diseases, genetics)
What do you want to check if you suspect Post-testicular eitiology of infertility?
Physical Examination (vesectomy, cystic fibrosis, retrograde ejaculation, history of chlamydia)
What are three described interventions to counter the male factor?
intrauterine insemination, in vitro fertilization, intracytoplasmic sperm injection
If a husband can only produce less than 100 non-motile sperm, what intervention may be needed?
intracytoplasmic sperm injection (ICSI)
What are the two main causes of the tubal factor of couple infertility?
intentional (tubal ligation) and inadvertent (STD)
TRUE/FALSE the likelihood of infertility increase with more episodes of pelvic inflammatory disease?
TRUE; up to 75% after 3 episodes
What is the dangers of pregnancy after episodes of Pelvic inflammatory disease?
Ectopic pregnancy
What are the two ways to asses the tubal factor of infertility?
hysterosalpingogram and laparoscopy
What is the treatment of choice for moderate to severe tubal damage?
IVF
Even with IVF, what is the risk of ectopic pregnancy with women who have fallopian tube problems?
2 x risk
The presence of these (fluid filled tubes) can decrease the likelihood of successful IVF and are often removed prior to treatment?
Hydrosalpinx
This is the presence of endometrial glands and strom outside the uterus, and is accompanied by associated pelvic pain and infertility?
Endometriosis
What are the suggested theories for eitiology of endometriosis?
retrograde menstruation; metaplasia; induction; vascular/lymphatic/surgical; immune dysfunction
What are typical symptoms of endometriosis?
dysmenorrhea, intermenstrual pain, and dyspareunia
What are the three major causes for Ovulatory Dysfunction?
Hypogonadotropic Hypogonadism (secondary to prolactin excess); Eugonadotropic Hypogonadism; and Hypergonadotropic Hypogonadism
What results from excess prolactin which can lead to infertility?
inhibition of GnRH causing decreased LH and FSH (no ovulation)
What can cause excess prolactin?
Mostly pituitary prolactinomas; also medication, excessive nipple stimulation and pituitary lesions
How can hypothyroidism lead to infertility?
low thyroid > Increased TRH > Increased activity of pituitary (both TSH and Prolactin)> Prolactin inhibits GnRH > Low FSH and LH
Women with this syndrome frequently have insulin resistance, and their follicles can only reach a small size and rarely ovulate?
Polycystic ovarian syndrome
The achievement of menopause with evidence of estrogen deficiency with elevated FSH prior to age 40 is called what?
Premature Ovarian Failure
Premature ovarian failure leads to what (hypergonadotropic hypogonadism, eugonadotropic hypogonadism, hypogonadotropic hypogonadism)?
Hypergonadotropic (hypothalamus is still pumpin out GnRH) hypogonadism (gonads aint worth shit)
If a factor were to speed up a woman's loss of oocyte pool, what would be the result?
Infertility caused by diminished ovarian reserve
What is the pathogenesis of diminished ovarian reserve?
Competition for ovulation (15 egg brawl) is cut down by less oocyte pool (maybe only 3-4 eggs fight it out) this means that the stronger egg will not be the strogest egg possible.
What hormone is used to evaluate a women with possible diminished ovarian reserve?
FSH (higher levels mean that less follicles are being stimulated, if more were being stimulated you would have increased negative feedback by estrogen)
What kind of intervention is warranted in young women with diminished ovarian reserve?
Aggressive IVF (young women have less eggs but should be of good quality)
What is uterine didelphys?
Paramesonephric ducts failed to fuse > two cervix, two uterine horns
What is unicornate uterus?
One paramesonephric duct fails to form > one cervix and only one fallopian tube
What is uterine agenesis?
Both paramesonephric ducts fail to form
What is bicornate uterus?
two paramesonephric ducts come together and partially fuse
What kind of congenital anomaly will hysterosalpingogram NOT be able to detect?
Bicornate uterus or separate uterus
Intervention for congenital anomalies is only really good for which one(unicornate uterus, bicornate uterus, uterine didelphys, uterine septum)?
Uterine Septum
Benign neoplasms that arise from the myometrium and are predominantly made up of excessive and disorganized extracellula matrix are called what?
Leiomyoma
TRUE/FALSE Leiomyomas found inside the uterine cavity act much like IUD and decrease fertility and increase the likelihood of pregnancy loss?
TRUE;
TRUE/FALSE Subserosal leiomyomas result in pregancy loss and decreased fertility?
FALSE; only pressure and pelvic pain
In treating leiomyoma, what is the only therapy available for women who plan on future child-bearing?
Myomectomy (individualized removal)
This is an overgrowth of the endometrial lining, resulting in a mass of benign hyperplastic endometrium?
Endometrial polyp
What is the treatment for endometrial polyps?
Surgical removal by hysteroscopic resection
What is asherman syndrome?
scar tissue within the uterine cavity
What is asherman syndrome usually caused by?
prior uterine curettage (surgical removal of endometrium)
What is the treatment for asherman syndrome?
hysteroscopic resection of adhesive disease