Assessment of infertility

Question 1

Chocolate cysts

Answer 1

Endometriosis

Question 2

dysmenorrhoea (classically before menstruation), dysparenuia, menorrhagia, painful defaecation, chronic pelvic pain, uterus may be fixed and retroverted, scan may show characteristic ‘chocolate’ cysts on ovary, infertility, asymptomatic

Answer 2

Endomertriosis

Question 3

Tubal disease (infective causes)

Answer 3

Pelvic inflammatory disease (chlamydia, gonorrhoea, other: anaerobes, syphilis, TB)
transperitoneal spread: appendicitis, intra-abdominal abscess
following procedure: IUCD insertion, hysteroscopy, HSG

Question 4

Tubal disease (non-infective)

Answer 4

endometriosis
surgical (sterilisation, ectopic pregnancies)
fibroids
polyps
congenital
salpingitis isthmica nodosa

Question 5

45X

Answer 5

Turner’s

Question 6

hot flushes, night sweats, atrophic vaginitis

Endocrine Feature: high FSH, high LH, low oestradiol

Answer 6

Premature ovarian failure

Question 7

high free androgens, high LH, impaired glucose tolerance

Answer 7

PCOS

Question 8

obesity, hirsutism or acne, cycle abnormalities and infertility

Answer 8

PCOS

Question 9

FSH, LH and oestradiol levels in anorexia?

Answer 9

Low

Question 10

Endocrine conditions which could cause MALE infertility

Answer 10

Acromegaly, cushings disease, hyperprolactinemia
Anorexia
Hyper/hypothyroidism

Question 11

Globospermia

Answer 11

Could cause male infertility

Question 12

Kartagner’s syndrome

Answer 12

Causes male inferility

Question 13

Clinical Features: 
normal testicular volume
normal secondary sexual characteristics
vas deferens may be absent
Endocrine features:
Normal LH, FSH and testosterone

Answer 13

Obstructive

Question 14

Clinical Features: 
low testicular volume
reduced secondary sexual characteristics 
vas deferens present
Endocrine features:
High LH, FSH and low testosterone

Answer 14

Non-obstructive

Question 15

When would you do midluteal progesterone level

Answer 15

Day 21/28 (or week before period is due)

Normal levels >30 suggest ovulation

Question 16

Hysterosalpingiogram

Answer 16

Test of tubal patency

if you have any indication that there is problem, just do laparoscopy. Laparoscopy is gold standard

Question 17

When would you do hysteroscopy?

Answer 17

Performed in cases where suspected or KNOWN endometrial pathology (e/g/ adhesions, polyp)

Question 18

How much semen is normal?

Answer 18

> 1.5ml

Question 19

Normal semen motility?

Answer 19

> 50%