Infertility

Question 1

What is the definition of infertility?

Answer 1

A failure to conceive after 12 months of unprotected intercourse

Question 2

What is the incidence of infertility in the developed world?

Answer 2

1/4 couples

Question 3

Which hormones are measured to assess normal ovulation in a fertility clinic?

Answer 3

• FSH
• E2
• P4
• AMH

Question 4

Lower reference limits for male sperm:

Count \_\_\_ M/mL
Motility \_\_\_% progressive + non progressive
Volume \_\_\_\_ mL
Total # \_\_\_\_ m
Morphology \_\_\_\_%

Answer 4

Count = 15 M/mL
Motility=  40% progressive + non progressive
Volume = 1.5 mL
Total # = 3.9m
Morphology = 4 %

Question 5

What is a common cause of anovulation?

Answer 5

Being under/overweight

Question 6

Clomiphene citrate is a selective ____ receptor modulator

Answer 6

Oestrogen

Question 7

Which drugs can be used to treat anovulation?

Answer 7

• FSH
• Clomiphene citrate
• Letrozole

Question 8

What is the first line treatment for Polycistic Ovarian Syndrome (PCOS)?

Answer 8

Weight loss

Question 9

Which drugs can be used to treat PCOS?

Answer 9

• Metformin
• Clomiphene citrate
• FSH

Question 10

What are the treatment options for tubal disease?

Answer 10

Surgery or IVF

Question 11

What is the treatment for cervical problems?

Answer 11

IUI (Intra-uterine insemination)

Question 12

What are the treatment options for endometriosis?

Answer 12

• Hormonal contraceptives

- Surgical ablation

Question 13

What is an advantage of letrozole over clominephine citrate?

Answer 13

A greater chance of single pregnancy

Question 14

What are the 6 steps in IVF?

Answer 14

1. Ovarian stimulation
2. Egg retrieval
3. Sperm preparation and fertilisation
4. Embryo culture
5. Embryo transfer
6. Embryo freezing

Question 15

Why might a GnRH agonist be administered in the early stages of IVF?

Answer 15

To prevent ovarian hyperstimulation syndrome

Question 16

In IVF, the egg is collected ___ hours after the trigger injection

Answer 16

36

Question 17

How is IVF cycle tracking done?

Answer 17

• Transvaginal ultrasound scans

- Blood tests (oestrogen, progesterone)

Question 18

Why is IVF cycle tracking done?

Answer 18

• Prevent premature rise of progesterone, affects quality of eggs and lining of uterus

Question 19

What needs to be seen on a transvaginal ultrasound before being able to trigger?

Answer 19

3 follicles, at least 17mm each

Question 20

At what stage is the lab media changed for the growing embryo in IVF?

Answer 20

8 cell stage (day 3)

Question 21

How is the lab culture made as close to physiological conditions as possible?

Answer 21

• Incubator is 5-6% CO2

Question 22

What are the three abnormalities in OATS (oligoasthenoteratospermia)?

Answer 22

• Low concentration
• Poor motility
• Irregular morphology

Question 23

Congenital absence of the vas deferens is present in almost 100% of ____ patients

Answer 23

Cystic fibrosis

Question 24

What are four causes of azoospermia?

Answer 24

1. Kallman’s syndrome
2. No spermatogenesis
3. Obstructive/vasectomy
4. Non-obstructive

Question 25

What are three methods of surgical removal of sperm?

Answer 25

1. PESA = percutaneus epididymal sperm aspiration 2. TESA = testicular sperm aspiration 3. TESE = testicular sperm extraction

Question 26

What as an important factor in unexplained fertility?

Answer 26

Age

Question 27

How is unexplained fertility treated?

Answer 27

Mild stimulation with IUI or IVF

Question 28

40 year old eggs have more ____ issues and ____ defects

Answer 28

Mitochondrial | Chromosomal

Question 29

A patient with a high ovarian reserve may have _____

Answer 29

Polycystic Ovarian Syndrome

Question 30

What is aneuploidy?

Answer 30

An abnormal number or arrangement of chromosomes

Question 31

What are the benefits of time-lapse photography and single step media?

Answer 31

- Undisturbed culture - Algorithms predict embryos with best potential - No more snapshot selection

Question 32

What is a benefit of PGD?

Answer 32

- Only put back embryos we know have a complement of chromosomes

Question 33

How is PGD achieved?

Answer 33

Trophodecterm biopsy | Hole in zona -> cells herniate -> biopsy -> analyse

Question 34

What are three recent innovations in IVF?

Answer 34

- Time lapse photography and single step media of IVF - PGS - Egg freezing