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77 Cards in this Set
- Front
- Back
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Normal Cycle Fecundity based on 1, 3, 6, and 12 months?
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1 mo: 20%
3: 50% 6: 75% 12: 85-90% |
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6 elements of Pre-Conceptional Counseling?
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1) Good FH (pedigree)
2) Immunity to Rubella 3) Multivitamin for folic acid 4) Check Meds 5) Screen for genetic diseases 6) Assess Medical Problems |
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Which ethnicity is more at risk of sickle cell?
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AA's
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Which ethnicity is more at risk of thalassemias?
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AA
Mediterraneans Asians |
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Which ethnicity is more at risk of tay sachs?
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Ashkenazi Jews
French Canadians |
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Which ethnicity is more at risk of NTDs?
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English/Irish
South Americans Northern Chinese |
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Which ethnicity is more at risk of Canavan disease?
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Ashkenazi Jews
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Which ethnicity is more at risk of Gauche disease?
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Ashkenazi Jews
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Which ethnicity is more at risk of CF?
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Caucasians
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When is Rubella exposure superbad?
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1st trimester
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at what rate does first trimester exposure to rubella cause problems?
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50%
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What are the common problems caused by rubella?
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Mental Retardation
Microcephaly Congenital defects of heart and eye Deafness |
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Increased risk of Rubella complications in who?
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Hispanics
Foreign Born |
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How long after booster/vaccine can you safely attempt pregnancy?
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1 month
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Different doses of Folic acid and their effects on NTD rate?
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0.4 mg several months in advance dec risk by 50%
4.0 mg in women w/ prior NTD kid Decreases risk by 70% |
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What type of women should definitely get 4mg of folic acid?
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Seizure disorders on valproate
Diabetics |
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How do you test for sickle cell or thalassemias?
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CBC and Hb electrophoresis
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How do you test for Tay Sachs?
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-Hexosaminidase A serum test if not pregnant or on OCP
-Otherwise cultured WBC -Maybe DNA |
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Test for CF, Canavan, Gauche?
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DNA Tests for specific mutations
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Risk of chromosomal abnormalities in a 45 year old mom?
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1/30
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How long do you have to be failing to get pregnant before infertility is really a question?
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1 year
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Big Red Lights to infertility?
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H/O irregular periods
H/O PID or STD Advanced age >35 with >6 months of infertility |
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Three Absolute Requirements for pregnancy
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Sperm
Ovulation At least one patent tube |
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Components of the Infertility Evaluation?
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1. Sperm Analysis
2. Hysterosalpingogram (open tubes?) 3. Assess Ovulation |
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How do you "assess ovulation?"
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Usually TSH and PRL
Maybe fasting CMP, Insulin (if PCOS) CD2-3 FSH in > 35yo FSH, LH, and progesterone don't really help |
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WHO Criteria for Good sperm analysis?
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1.5-5 cc's
20 million/cc 50% motility 30% normal forms |
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According to Kruger, what percent of sperm need good morphology to get normal rates of fertilization?
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>14%
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What if its < 4%?
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7-8% fertilization
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How many times should you analyze the sperm?
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Repeat if abnormal
Some suggest at least twice anyways |
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How do you treat infertility if the problem is with the guy?
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Intrauterine Insemination (IUI)
Donor Insemination IVF |
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If there are sperm abnormalities what do you do next?
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Exam for man boobs and testes size
Test endocrine axis (testosterone, LH, FSH, etc) |
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Two types of hypogonadism?
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Hypergonadotropic hypogonadism (gonad failure)
Hypogonadotropic hypogonadism (kallmann) |
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what syndrome causes big nuts?
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Fragile X Syndrome
but they're still infertile |
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when can you do IUI?
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>10million motile sperm
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how big does an ovarian follicle usually get?
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20mm
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What is up with basal body temperature?
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It goes up with ovulation around day 14. It increases about 1 degree
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What happens to the BBT after ovulation?
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it goes back down w/o pregnancy, but stays up w/ pregnancy
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What's up with a Urine LH Kit?
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you compare the color of the strips each day and when it matches the "test" strip you're ovulating (LH surge)
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What is a good way to confirm ovulation?
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Serum progesterone should be 3-5ng/mL
Urinary LH test has good correlation too |
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When do you have ovulation disorders?
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Adolescence (common for 1-2 yrs after periods start)
Near Menopause Thyroid Disease Elevated PRL PCOS Overactive Adrenal Gland |
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Where do thyroid and PRL issues affect the ovulation mechanism?
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they interfere w/ GnRH getting to the pituitary
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Where do the androgens screw things up?
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Somewhere down near the ovary...not really sure
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hormone levels in hypergonadotropic hypogonadism?
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High FSH and LH
Low sex steroids due to gonadal failure (no neg feedback) |
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Examples of syndromes leading to Hypergonadotropic hypogonadism?
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Turner's
Swyer |
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Where is the defect in hypogonadotropic hypogonadism?
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Hypothalamus or Pituitary
so low levels of everyone |
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What is the most common cause of not ovulating?
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PCOS (70%)
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Definition of PCOS?
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Hyperandrogenic anovulation
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Signs and Sx's of PCOS?
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Irregular or absent periods (infertility)
Hair Growth (face, neck, chest) or high androgens May or may not have polycystic ovaries on U/S |
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Risks associated w/ PCOS?
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Inc risk of endometrial hyperplasia (cancer)
Inc risk of diabetes (30% risk) |
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Sx's of Hyperthyroidism?
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Wt loss
Moist skin diarrhea difficulty sleeping |
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Sx's of Hypothyroidism?
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Wt gain
Dry Skin Constipation Fatigue |
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What can hypo and hyper-thyroidism have in common?
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anovulation
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Sx's of High PRL?
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Possible anovulation
Abnormal Periods Breast discharge HA Visual Abnormalities |
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What happens to FSH around menopause?
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it gets higher and higher
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Rx for Hyperprolactinemia?
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Bromocriptine (dopamine agonist)
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Rx for Hypothyroidism?
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T4
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Rx for PCOS?
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Clomiphene citrate (1st choice)
Metformin + clomiphene (if resistant) Gonadotropins (3rd choice) |
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What does clomiphene citrate do?
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-its a selective estrogen receptor modulator
-works predom in hypothalamus |
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SE's of CC?
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multiple births (5-8%...mostly twins)
Hyperstimulation: pain (rarely severe) Hot Flashes, Nausea, HA |
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SE's of metformin?
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Nausea
Abd Pain Diarrhea Lactic Acidosis |
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Administration of PCOS meds?
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Metformin and CC are pills
Gonadotropins are S.Q. |
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SE's of Gonadotropins?
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Multiple Births (20-30%...and they can make a bunch)
Hyperstimulation: pain...can be severe |
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main cause of tubal disease?
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Chlamydia of cervix
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If you have a normal HSG, no infection, and no surgical history...
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then you don't have tubal disease
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HSG Guidelines?
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Done after period, before midcycle
Done in radiology Take NSAID before procedure |
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SE's of HSG?
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Bleeding
Infection Cramping (common) |
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Rx for Tubal Disease?
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Laparoscopy (Dx and Rx)
IVF Salpingectomy if IVF fails |
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% of reproductive age women affected by endometriosis?
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2-3%
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In infertile women, what % are diagnosed w/ Endometriosis?
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20-68%
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Common Sx's of endometriosis?
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Dysmenorrhea
Pelvic Pain |
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Medical therapy for infertility in endometriosis?
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negative...no proof it helps
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How then do you increase pregnancy rates in women w/ endometriosis?
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Surgery
30% ove 9 months instead of 15% |
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how do you do IVF?
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Stimulate ovaries to produce mulitple eggs
Get sperm on day of egg retrieval Mix 'em Place embryos in uterus 3-5 days later |
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Indications for IVF?
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Tubal Disease
Male Factor (low or abnormal) Endometriosis, pelvic adhesions Infertility refractory to other Rx |
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Rx for unexplained infertility?
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CC/IUI (3 cycles)
--> IVF |
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Review: Initial Infertility Evaluation requires:
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1. Semen analysis
2. HSG 3. Rubella titer 4. Chlamydia test 5. Genetic screening 6. Anovulation/old mom--> check CD2-3 FSH, LH, PRL |
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Who gets sent to an REI?
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Not ovulatory after 2-3 rounds of CC
Not pregnant after 3-4 rounds of CC Endometriosis, pelvic adhesions, or tubal disease All women > 35 |
