Define sub fertility
“inability of couples to achieve clinical pregnancy after 12 months of regular unprotected sex”
Give 3 factors which may influence subfertility
- Age
- Duration of infertility (>3 years lessens chance of conception)
- Timing of intercourse (sperm need to be there before ovulation)
When should a sperm sample be obtained for semen analysis?
2-5 days after abstinence
Give the 3 normal values expected in semen analysis
- > 15million/ml
- > 40% motility
- > 4% normal sperm
Give 3 causes of male subfertility
- Defective sperm transportation
- Defective sperm production
- Hypogonadotrophism
Give 4 techniques used to investigate male subfertility
- History
- Testicular examination
- Semen analysis
- Karyotype
Define obstructive azoospermia
Normal sperm production but no sperm in ejaculations (blocked epididymis or vas deferens or congenital absence of vas in CF)
Define non-obstructive azoospermia
Testicular failure (increased FSH) or small testicular volumes (biopsy, karyotype for XXY?)
What is hypogonadotrophic hypogonadism?
Failure to stimulate spermatogenesis (rare).
What are the 3 groups in the WHO classification of an ovulation?
1: Hypothalamic pituitary failure
2: Hypothalamic-pituitary-ovarian axis dysfunction
3: Ovarian failure
How does hypothalamic pituitary failure present and what is its treatment?
Amenorrhoea and Low gonadotrophin
Tx: GnRH agonist
What are the Rotterdam criteria in which 2 out of 3 are needed to diagnose PCOS?
Biochemical or clinical evidence of androgen excess (more testosterone or hirsutism)
Amenorrhoea or oligomenorrhoea
TV USS features of PCO (string of pearls appearance)
What is the 1st line drug treatment in PCOS?
Clomifene
What is the 2nd line drug treatment in PCOS?
Letrozole
What condition results from ovaries over responding to gonadotrophin injections causing systemic disease?
Ovarian hyperstimulation
Give 3 causes of premature ovarian failure
Idiopathic
AI
Turner’s syndrome (45XO)
Give 2 causes of tubal subfertility
PID
Endometriosis
Give 3 investigations for tubal subfertility
- Chlamydia swab
- TV USS
- Laparoscopy and dye test
Give 3 types of assisted reproductive technology
- IVF
- Intrauterine insemination
- Donor sperm +/- donor egg
Give 4 points of eligibility of IVF in Scotland
- Co-habiting in stable relationship >2 years
- <42 y/o
- BMI >18.5 and <30
- Both non-smokers
