Assisted Conception Service

Question 1

How many couples experience problems with infertility?

Answer 1

1 in 7 heterosexual couples

Question 2

How is infertility defined?

Answer 2

1 year of unprotected vaginal intercourse in the absence of known causes of infertility in women of reproductive age

Question 3

How can occupation be relevant to history taking in terms of infertility?

Answer 3

People can be exposed to chemicals and toxins which decrease semen quality through their work
men who drive for long periods of time as part of their work will increase their scrotal temperature and thus decrease the quality of their semen

Question 4

People who take recreational drugs are eligible for infertility treatment on the NHS. T/F?

Answer 4

False

Question 5

A women’s BMI must be between what range in order to qualify for infertility treatment on the NHS?

Answer 5

18.5-30

Question 6

What procedures should be undertaken initially in primary care if a couple presents with infertility?

Answer 6

Chlamydia and gonorrhoea swabs
BMI calculation
Enquire about rubella status
Educate on important of cervical smears

Question 7

What percentage of cases of infertility does an ovulation account for?

Answer 7

25%

Question 8

What test is carried out to see if a women is ovulating or not?

Answer 8

A progesterone test 7 days before the start of the next period

Question 9

Antral follicles can be seen as a dark ‘string-of-pearl’ shaped ring in the uterus on ultrasound. What would constitute a normal astral follicle count?

Answer 9

4-16

Question 10

What is the normal range for anti-mullerian hormone for women of reproductive age?

Answer 10

5.4pmol/l - 25pmol/l

Question 11

At what point in a women’s reproductive cycle should baseline FSH and LH assessment be carried out?

Answer 11

First 1-3 days of the period

Question 12

What is the normal ratio of FSH to LH?

Answer 12

FSH should be 1.5 times greater than LH

Question 13

85% of cases of an ovulation are due to…?

Answer 13

Hypothalamic-pituitary-ovarian axis dysfunction

Question 14

Only 5% of cases of an ovulation are due to…?

Answer 14

Ovarian failure

Question 15

How is ovarian failure treated in infertile women?

Answer 15

Oocyte donation

Question 16

How is hypothalamic-pituitary dysfunction treated in infertile women?

Answer 16

Lifestyle adjustment

Gonadotrophins with LH

Question 17

How is hypothalamic-pituitary-ovarian axis dysfunction create din infertile women?

Answer 17

Gonadotrophinstrophins / letrozole / metformin

Question 18

What percentage of cases of infertility does semen dysfunction account for?

Answer 18

30%

Question 19

What is the normal pH of semen?

Answer 19

7.2

Question 20

What is the normal concentration of sperm in semen?

Answer 20

15 million sperm per ml of semen

Question 21

What should the total sperm count per ejaculate be?

Answer 21

39 million sperm

Question 22

What percentage of sperm in a semen sample should be progressively mobile?

Answer 22

40%

Question 23

How soon do samples of semen for analysis need to be received by the lab after they are produced?

Answer 23

1 hour

Question 24

What treatments can be offered for infertility due to semen dysfunction?

Answer 24

IUI and ICSI

Question 25

What is ICSI?

Answer 25

A procedure where sperm is injected directly into the cytoplasm of the egg

Question 26

What is IUI?

Answer 26

Artificial insemination using a sperm donor

Question 27

What investigations should be carried out into male fertility?

Answer 27

``` Karyotyping Check for Cystic Fibrosis Check FSH levels Semen analysis Look for blockage of urethra or ductus deferent ```

Question 28

What percentage of cases of infertility does uterine tube dysfunction account for?

Answer 28

20%

Question 29

What procedures can be used to investigate the uterine tubes for infertility?

Answer 29

Hystero contrast sonography hysterosalpinography laparoscopy with dye

Question 30

What treatments are available for infertility due to uterine tube dysfunction?

Answer 30

IVF clipping salpingectomy

Question 31

What percentage of cases of infertility do disorders of the uterus and/or peritoneum account for?

Answer 31

10%

Question 32

When is an endometrial scratch treatment used in infertility clinics?

Answer 32

If there is recurrent implantation failure

Question 33

What treatments can be used for infertility caused by uterine and peritoneal disorders?

Answer 33

Laparoscopic disthermy Septoplasty Endometrial scratch

Question 34

What percentage of cases of infertility have no known cause?

Answer 34

25%

Question 35

How is infertility of unknown cause treated?

Answer 35

IVF

Question 36

A maximum of how many embryos can be inserted into the uterus of a women under the age of 40?

Answer 36

2

Question 37

What percentage of couples who receive IVF treatment will go on to have a baby?

Answer 37

33%

Question 38

A maximum of how many embryos can be inserted into the uterus of a woman between the age of 40 and 42?

Answer 38

3

Question 39

When collecting eggs for IVF/ICSI treatment, a women is given a hormone injection to down regulate the normal reproductive cycle on which day of her cycle?

Answer 39

Day 21

Question 40

Following her period, a woman will be given injections of which hormone for 8-15 days to stimulate oocyte production for IVF/ICSI treatment?

Answer 40

FSH

Question 41

To collect oocytes for IVF treatment, a woman is given a final hCG booster injection how many hours before egg retrieval?

Answer 41

38 hours

Question 42

How are the oocytes collected from a woman for iVF treatment?

Answer 42

Aspiration guided by ultrasound

Question 43

How is ICSI different from IVF?

Answer 43

Rather than just mixing sperm and oocytes together and waiting for fertilisation to occur as in IVF, with ICSI an embryologist injects a single sperm into the cytoplasm of the oocyte.

Question 44

In what year did Scotland update its provision of IVF and ICSI to allow funding for 3 cycles of IVF/ICSI for eligible couples?

Answer 44

2017