Causes And Treatments Of Subfertility

Question 1

Infertility

Answer 1

Failure to achieve pregnancy after one year of frequent unprotected sex

6 months of 2nd infertility and women over 36

Question 2

Infertility affects how many couples?

Answer 2

1:6

Question 3

Refer for early specialist consultation when?

Answer 3

1. Women over 36
2. Known cause of infertility or history of predisposing factors
3. Investigations show no chance of pregnancy with expectant management

Question 4

Female factors?

Answer 4

PCOS, premature ovarian insufficiency, hypopituitarism, radioChemo therapy

Tubual blockage, PID, endometriosis, ectopic pregnancy

Limited ovarian reserve, polyp, fibroid, synechiae (bonding of scar tissue)

Question 5

Basic infertility checks?

Answer 5

History and examination

FSH,LH, oestrdiol, TFT, Day 2-3 of period

Mid luteal progesterone

Chlamydia swab and rubella

HSG- xray for inside of uterus and fallopian tubes

Pelvic ultrasound

Question 6

Granulosa cells secrete?

Answer 6

Anti-mullerian hormone

Question 7

With age, AMH?

Answer 7

Decreases

Question 8

Most useful investigations in women?

Answer 8

Antral follicle count and pelvic ultrasound

FSH, LH, oestrogen and AMH

Question 9

Ovulation meds?

Answer 9

Clomid, letrozole and FSH injection

Question 10

Which scan with dye?

Answer 10

Hyscosy

Question 11

Volume of semen?

Answer 11

2-6ml

Question 12

In semen abnormal forms should be?

Answer 12

Less than 96%

Question 13

Motility of sperm should be?

Answer 13

Over 40%

Question 14

Count of sperm?

Answer 14

15 x 10 to the power of 6 per ml

Question 15

For unexplained infertility?

Answer 15

1. Do not offer IUI
2. Do not offer oral ovulation stimulation
3. Offer IVF for women who have not conceived after 2 years

Question 16

How many cycle of IVF offered under age of 40?

Answer 16

3

Question 17

Which drug helps with live birth?

Answer 17

Clomiphene

Question 18

For IVF collection and prevent ovulation which 2 injections are given?

Answer 18

FSH and buserelin

Question 19

For men with low sperm quality you would use?

Answer 19

Intra cytoplasmic sperm injection

Question 20

When will further clinical assessment and investigation be conducted in a woman using artificial insemination?

Answer 20

If she hast conceived after 6 cycles

Question 21

Offer once cycle of IVF to women aged 40-42 if??

Answer 21

1. Hasn’t had IVF before
2. No evidence of low reserve
3. implications of pregnancy