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Endocrine Pathologies - Infertility
Infertility
49
Physiology
Undergraduate 3
12/11/2013

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Cards

Term
Define infertility
Definition
No conception after 1 year of frequent, unprotected intercourse
Term
What percentages are associated with a male factor? Female? Both?
Definition
40 % male, 40% female, 20% male and female
Term
Which three hormones act in a negative feedback fashion on the Hypothal-Pit-Gonadal axis, and where does each act?
Definition
1. Progesterone - acts on both hypothalamus and pituitary
2. Estrogen - acts at pituitary
3. Inhibin - acts at pituitary
Term
Name 3 structural causes of male infertility?
Definition
1. Bilateral absence of vas deferens
2. Varicose veins in the spermatic cord
3. Undescended testes
Term
Which structural cause is cystic fibrosis associated with?
Definition
Absence of the vas deferens
Term
Name 2 environmental causes of male infertility
Definition
1. Temperature
2. Chemical toxins
Term
What are the two causes of drug induced male infertility?
Definition
1. Anabolic androgenic steroids
2. Finasteride (for alopecia treatment)
Term
What are signs of hypogonadotropic-hypogonadism caused by anabolic androgenic steroids?
Definition
- Decreased testosterone
- Testicular atrophy
- Impaired spermatogenesis
- Lowered intratesticular testosterone levels
Term
What does finasteride do?
Definition
Inhibits the conversion of testosterone to dihydrotestosterone by 5alpha-reductase, which means there is more negative feedback on the pituitary gland. This means less FSH, and thus, reduced spermatogenesis
Term
What are the 5 aspects of semen that are tested in a semen analysis?
Definition
1. Volume
2. Viscosity
3. Sperm density
4. Sperm motility
5. Sperm morphology
Term
What is a normal volume?
Definition
2-4 mL
Term
What density is considered normal?
Definition
> 20million/mL
Term
What motility is considered normal?
Definition
> 40% motile
Term
What morphology is considered normal?
Definition
> 40% normal forms
Term
List the positive feedback hormones of the MRS and what they do?
Definition
1. GnRH - trigger FSH and LH release
2. LH - survival of leydig cell
3. FSH - induces spermatogenesis
4. Testosterone - supports spermatogenesis
Term
List the negative feedback hormones of the MRS and where they act?
Definition
1. Testosterone - pituitary and hypothalamus
2. Inhibin - pituitary
Term
What are two treatments for male infertility?
Definition
1. Lifestyle changes
2. Fertility enhancement
Term
Describe 3 fertility enhancement procedures
Definition
1. Intrauterine insemination of concentrated sperm
2. In vitro fertilization
3. Intracytoplasmic sperm injection combined with IVF
Term
(T/F) Medical therapies exist for male infertility
Definition
False
Term
Name 4 causes of female infertility
Definition
1. Anovulation
2. Structural
3. Immunologic
4. Age
Term
What are two immunological causes?
Definition
1. Ab production against sperm
2. Immune response to fetus (ie rhesus)
Term
What is anovulation?
Definition
Lack of menstruation
Term
What are 3 causes of primary amenorrhea (anovulation)?
Definition
1. Menarche never occured
2. Genetic disorders (Tuners syndrome)
3. Congenital disorders of brain/pituitary/ovary/uterus
Term
What is seen with secondary amenorrhea?
Definition
Cesseation of menstrual cycles after a period of regular cycles
Term
What are the causes of secondary amenorrhea?
Definition
1. CNS or pituitary tumours
2. Inhibition of GnRH secretion
3. Obstruction of outflow tract
Term
What is leiomyoma?
Definition
A benign tumour (fibroid) in the myometrium
Term
What is ashermans syndrome?
Definition
Scarring of the uterine lining
Term
How is secondary amenorrhea treated?
Definition
1. Surgical resection of tumours
2. Education
3. Oral contraceptive (if not trying to conceive)
4. Endocrine therapy
Term
How is bromocryptine used in endocrine therapy?
Definition
Suppresses PRL
Term
How is clomiphene used in endocrine therapy?
Definition
Stimulates gonadotrophin to proper levels
Term
What is exogenous gonadotrophin therapy used for?
Definition
Fertility treatment
Term
What is the cause of endometriosis, a structural cause of female infertility?
Definition
Ectopic endometrium
Term
What are two symptoms?
Definition
1. Scarring
2. Pain
Term
What is dysmenorrhea?
Definition
Pain during menses
Term
What is dyspareunia?
Definition
Pain during intercourse
Term
What is the primary goal for treatment of endometriosis?
Definition
Inhibiting ovulation
Term
What 3 things are used to accomplish this?
Definition
1. GnRH agonist
2. Androgenic steroid (danazol)
3. Oral contraceptive
Term
What is another structural cause of female infertility?
Definition
Blocked fallopian tubes
Term
What causes pelvic inflammatory disease, and what is the consequence of this disease?
Definition
Causes: STI or ruptured appendix
Consequence: blocked fallopian tubes
Term
What treatments are used for structural causes of female infertility?
Definition
1. Surgical ranastomosis
2. Resection of endometriosis
3. In vitro fertilization
Term
What percent of women are affected by polycystic ovary syndrome?
Definition
5-7%
Term
List characteristics of PCOS
Definition
- Anovulation or oligo-ovulation
- Hyperandrogenism
- Polycystic ovaries
- Elevated LH:FSH (not always)
- Insulin resistance
- Obecity
Term
(T/F) The cause of PCOS is known
Definition
False
Term
What are some treatments for PCOS, when fertility is not a concern?
Definition
Oral contraceptives
Term
What are some treatments for PCOS, when fertility is a concern?
Definition
1. Weight loss
2. Clomiphene
3. Metformin
4. Gonadotropin
Term
What is the function of clomiphene?
Definition
Stimulates ovulation by stimulating FSH
Term
What is the function of metformin?
Definition
Induces weight loss and menstrual activity
Term
What is the function of gonadotropin?
Definition
Induces ovulation in vitro
Term
What are two surgical management tactics used to overcome female infertility?
Definition
1. Ovarian wedge resection (no longer used)
2. Laparoscopic ovarian diathermy (ovarian drilling)
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