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