5.3 Managment of Infertility

Question 1

What is infertility?

Answer 1

Actively trying for 12 months without falling pregnant

Question 2

What are the causes of male infertility?

Answer 2

Sperm count 
(Azoospermia - no sperm, oligospermia - low sperm numbers)
Sperm quality  
Anti sperm antibody
Sexual dysfunction 
Lifestyle factors

Question 3

What is azoospermia and what are the two kinds and give examples

Answer 3

No sperm
Production problem: Kleinfelters, anabolic steroids affecting the feedback
Obstructive problem: cystic fibrosis (no vas deferens)

Question 4

What is oligospermia and what are the causes

Answer 4

Low sperm numbers
Testicular dystrophy (mumps as a child)
Undescended testis not corrected at an early age (cryptoorchaism)

Question 5

What is the name for poor sperm motility?

Answer 5

Asthenospermia

Question 6

What is the name for poor sperm morphology?

Answer 6

teratospermia

Question 7

What can be done for male infertility problems?

Answer 7

Lifestyle changes - weight loss, reduce alcohol and stop smoking, alter medications, better management of medical conditions
Increased sperm turnover may reduce chromatin damage
Pharmacological treatment of erectile dysfunction

Question 8

Causes of female infertility

Answer 8

Ovulation disorders (PCOS) 
Structural problems (fallopian tube occlusion) 
Endometriosis 
Sexual dysfunction 
Lifestyle factors

Question 9

What is fecundability?

Answer 9

The monthly chance of getting pregnant

Question 10

What effect does ageing have on fertility?

Answer 10

mitochondrial dysfunction
increase prevalence of aneuploidy in ageing oocytes
Increase incidence of spontaneous miscarriage

Question 11

What investigations would you do on the female?

Answer 11

History 
Serology 
Pap smear 
Antenatal screen 
Pelvic ultrasound 
Hormones day 2 and 21 of cycle  
HyCosi for tubal patency

Question 12

What investigations would you do on the male?

Answer 12

Semen analysis

trial wash

Question 13

What would you look for in a semen analysis?

Answer 13

Volume, concentration, motility, morphology and anti-sperm antibody

Question 14

what importance is anti-mullerian hormone?

Answer 14

Produced by the pre-antral follicles in the ovary and if there is no eggs there will be low AMH levels
tells about the reserve of eggs and predicts the response to IVF

Question 15

When would you use karyotyping?

Answer 15

Men: severe oliogospermia
women: POF, poor ovarian reservem premature menopause
Couple: recurrent miscarriage and IVF failure

Question 16

What are the fertility options?

Answer 16

Ovulation tracking 
Ovulation indication 
Artificial insemination (ICSI)
IVF 
Egg donation 
Sperm donation 
Pre implantation diagnosis

Question 17

What are the indications for IVF

Answer 17

Tubal obstruction 
Endometriosis 
Unexplained infertility 
Male factor infertility 
pre implantation genetic diagnosis

Question 18

what is the IVF cycle

Answer 18

Interview and trial wash 
ovarian stimulation 
10-14 days later egg collection 
embryo transfer 
endometrium support 
pregnancy test

Question 19

when would you use intracytoplasmic sperm injection?

Answer 19

as treatment for male factor infertility 
obstruction 
oligospermia 
poor motility 
poor morphology 
sexual/erectile problems 
genetic disorder

Question 20

What testing is done before implantation?

Answer 20

Single gene defects
translocations
screening for aneuploidy
HLA typing

Question 21

what are the techniques for genetic diagnosis and when are they used?

Answer 21

CGH (comparative genomic hybridization)
- comprehensive chormosomal screening
PCR
- specific gene mutations

Question 22

What is needed for pre implantation genetic diagnosis

Answer 22

ideally molecular diagnosis known in advance