Infertility

Infertility is defined as the inability to conceive within ______ months

12

For patients over the age of 35, infertility is defined as the inability to conceive within ________ months

6

Infertility can be categorized into:

• Primary infertility

• Secondary infertility

What’s the difference between these?

Primary: unable to conceive first child

Secondary: has a child but struggling to conceive second

Male infertility can be a result of:

• Inadequate number of sperm (or none)

• Decreased sperm motility

• Obstruction of spermatic ducts or vas deferens

• Scrotal varicocele

When the veins wrapping around the spermatic cord are dilated. Appears as vascular black looking bubbles on ultrasound. What infertility problem is this referring to:

Scrotal varicocele

• Hormonal imbalances

• Mullerian/structural abnormalities

• Endometriosis

• Ovaries (such as PCOS)

• Fallopian tube complications (PIS, adhesions, etc.

The following are all contributors to:

infertility in women

Impaired functional activity of the gonads (ovaries/testicles) with resulting hormonal imbalances is termed:

Hypogandism

If the hypothalamic pituitary gonadal axis is interupted at any level for any reason it is broadly defined as ________________

Hypogandism

True or false: Only males can be affected by hypogonadism

False; women can be affected too

Hypergonadotropic hypogonadism is associated with primary or secondary hypogonadism

Primary

Primary hypogonadism can be congenital or acquired. Why is it referred to as hypergonadotropic hypogonadism?

Production of the hormones estrogen/testosterone are greatly depleted sooooo the hypothalamus and pituitary are working overtime (hyperactive) to stimulate the hormone levels

Hypergonadotropic hypogonadism is associated with

• ________ FSH & LH

• _________ estrogen/testosterone (sex steroids)

High; low

___________________ occurs due to problems with either the hypothalamus or pituitary gland

Secondary: hypogonadotropic hypogonadism

Hypogonadotropic hypogonadism is associated with

• ________ FSH & LH

• _________ estrogen/testosterone (sex steroids)

• Low FSH & LH: follicles will not be stimulated

• Low: ovulation will not occur

a condition in which the pituitary gland produces too much prolactin is associated with ______________ hypogonadism and is termed _________________

Hypogonadotropic; hyperprolactinemia

If there is a not enough progesterone produced in the luteal phase, the endometrial lining may appear _________ than expected on ultrasound

thinner

• Associaited with infertility and very early pregnancy loss

Which patient is likely to have fertility problems?

Patient on the right because the fibroid is larger and more centrally located (pushing into the endometrium)

Why are congenital uterine anomalies, which result from defects in Müllerian duct development, often associated with renal anomalies?

Because the reproductive and urinary systems develop at the same time during development

Name the uterine anomaly

Bicornuate uterus: caused by partial failure of fusioon

Name the uterine anomaly

Bicornuate uterus: caused by partial failure of fusioon

Name the uterine anomaly

Uterus didellphys: failure of fusion resulting in 2 uteri, 2 cervices and 2 vaginal canals

• Best proved in transverse

Name the uterine anomaly

Unicornute uterus: usually only has one functioning fallopian tube. May have a rudimentary horn

Name the uterine anomaly

Septate uterus: A single wide fundus but with two uterine cavities (septum in the middle)

The septum is only partially dividing the uterine cavity. Name the uterine anomaly

Subseptate uterus

Which uterine anomaly is caused by DES (diethylstilbestrol) which is linked to vaginal cancer?

T shaped uterus

When evaluating the cervix a diameter of less than ____mm may indicate cervical stenosis

1mm

When assessing the endometrium the sonographer evaluates what three things:

1) thickness

2) echgenicity

3) contour (should be homogenous)

Identify the endometrial phase

During menstruation (may even see movement)

Identify the endometrial phase

early proliferative

Identify the endometrial phase

Late proliferative (2 line sign)

Identify the endometrial phase

Secretory phase: uniformly echogenic and thick

A surgical method used to evalute the fallopian tubes. Considered the gold standard as there will be a definitive diagnosis

Laparoscopy

Which type of procedure involves inserting a catheter through the cervix and injecting contrast/dye to evaluate the uterus and fallopian tube

HSG

A follicle in the ovary measuring greater than ______ is considered cystic

2.5

With this condition follicles grow but ovulation will not occur

PCOS

Define anovulation

an absence of ovulation

The “string of pearls sign”: a rounded ovary with multiple small immature follicles on the periphery is what condition?

PCOS

What is the difference between “in vitro” and “in vivo”

• In vitro: fertilization occurs in a lab setting “in the glass”

• In vivo: fertilization occurs in the mother “in the living”

common infertility treatment options: Medications are given between days 3-5 in order to cause development and enlargement of many follicles. Follicles are then imaged and measured. They should measure 15-20mm

Ovarian induction (stimulation) therapy

GIFT (Gamete intrafallopian Transfer)

“put the sperm & the egg in the correct spots within the body so they can meet for their blind date”.

• The eggs and sperm are placed in the correct spots through a catheter and fertilization will take place in vivo (within the woman’s body)

ZIFT: Zygote Intrafallopian transfer

Fertilization occurs outside the body and the zygote is then implanted

Intrauterine inseination is used to treat male infertility. What is it??

A catheter containing sperm is placed into the uterine fundus

Ovarian hyperstimulation syndrome (OHSS)

a potential complication of ART in response to medication the ovaries enlarge due to the follicles being overstimulated