Infertility

Question 1

80% of couples will conceive in one year IF

Answer 1

Women is under 40 y/o AND

They do not use contraception and have regular sexual intercourse

Question 2

Biochemical measurements of hirsutism

Answer 2

Testosterone 
Androstenedione 
Dehydropiandrosterone (DHA)
Dehydroepiandrosterone sulphate (DHAS)
17-OH-Progesterone
Sex hormone binding globulin (SHBG)

Question 3

Baseline investigations for female partner

Answer 3

Rubella immunity
Chlamydia has to be negative
TSH
If periods are regular = mid luteal progesterone (7 days prior to expected periods)
If periods are irregular = day 1-5 full hormonal profile (FSH, LH, PRL, TSH, testosterone)

Question 4

Baseline investigations for male partner

Answer 4

Semen analysis

Question 5

Testing for ovulation

Answer 5

Regular cycle = blood test to measure serum progesterone in mid luteal phase of their cycle (day 21 of 28)

Irregular prolonged cycle = blood test to measure serum progesterone - needs to be done later in the cycle and repeated weekly until next period

Irregular cycle = blood test to measure serum gonadotrophins (LH and FSH)

Question 6

When to refer to infertility clinic

Answer 6

Trying for one year
Unless there is a problem e.g. 
- Period irregularity 
- PMH
- testicular problem 
Abnormal tests 
HIV/Hep B
Anxiety

Question 7

Treatment of ovulatory disorders

Answer 7

Treat underlying cause
Weight loss/gains = BMI > 18 and < 35
Ovulation induction

Question 8

Ovulation induction drugs

Answer 8

Clomifene
Gonadotrophins
GnRH

Question 9

First line drug for ovulation induction

Answer 9

Clomifene

Question 10

Mode of action of clomifene

Answer 10

Oestrogen receptor modulation - binds to oestrogen receptors
Hypothalamus perceives hypoestrogenic state - pituitary increases release of gonadotrophins
Secondary site of action = direct effect on ovaries
So gives a positive trigger to release FSH and LH

Question 11

How many times can clomifene be used?

Answer 11

Up to 6 times

Question 12

Side effects of clomifene

Answer 12

Vasomotor

Visual

Question 13

Treatment of male infertility

Answer 13

IVF/ICSI
Intra uterine insemination 
Donor insemination 
Surgery 
- removal of vasectomy
- surgical sperm revival

Question 14

Investigations for azoospermia

Answer 14

History and exam

FSH, LH, testosterone, karyotype, PRL, CF screen

Question 15

How IVF works

Answer 15

1. Eggs harvested from ovaries
2. Eggs fertilised in lab with sperm
3. Embryos undergo a number of cell divisions
4. Embryos transferred to the womb

Question 16

Primary infertility meaning

Answer 16

If have had no children before

Question 17

Irregular periods definition

Answer 17

Variation of 7 days or more from the other months

Question 18

Side effects of any ovulation induction

Answer 18

Ovarian hyperstimulation

Multiple pregnancy

Question 19

How to diagnose tubal block

Answer 19

Salpingogram
HyCoSY
Laparoscopy to confirm

Question 20

Causes of tubal block

Answer 20

PID
If tubes are removed e.g. sterilisation
Endometriosis
Fibroids

Question 21

IVF meaning

Answer 21

In vitro fertilisation (outside the body)

Question 22

Azoospermia meaning

Answer 22

No sperm in the ejaculate

Question 23

Causes of azoospermia

Answer 23

Absence of vas deferens 
Mumps
Kleinfiers syndrome
STIs
Radiation 
Hypogonadism

Question 24

Unexplained fertility meaning

Answer 24

Everything is fine but there is still no fertility

Question 25

What is the overall success rate for IVF?

Answer 25

20 - 30 %

Question 26

What ethical issues could surround IVF?

Answer 26

``` Unnatural Funding Religion Criteria Risks ```

Question 27

What is IVF a moderate risk factor for?

Answer 27

Placental abnormalities

Question 28

How long do patients need to be trying to conceive for to be referred on?

Answer 28

1 year

Question 29

How many couples will be affected by infertility?

Answer 29

1 in 7

Question 30

Causes of inferility

Answer 30

``` Male factor 30% Unexplained 20% Ovulation failure 20% Tubal damage 15% Other causes 15% ```

Question 31

Key counselling points for conception

Answer 31

Folic acid Aim for BMI 20 - 25 Advise regular sexual intercourse every 2 - 3 days Smoking / drinking advise

Question 32

For people with unexplained fertility, mild endometriosis or mild male factor infertility who are having regular unprotected sexual intercourse, what can be done?

Answer 32

Make sure they try for 2 years naturally

Question 33

Common S/E of IVF

Answer 33

Ovarian hyper stimulation syndrome