Causes and treatments of subfertility

Question 1

What are the female factors that may cause infertility?

Answer 1

Ovulation disorder: PCOS, POF, hypopituitarism, Radiochemo treatment
Tubal blockage: PID, endometriosis, ectopic pregnancy
Age-related: limited ovarian reserve
Uterine problems: synechiae, polyp, fibroid

Question 2

Outline the basic infertility work up

Answer 2

History and examination of both partners
FSH, LH, oestradiol, prolactin TFT on day 2 or 3
Mid luteal progesterone (regular cycles)
Chlamydia swab and rubella
HSG
Pelvic ultrasound

Question 3

Which test measures the ovarian reserve?

Answer 3

antral follicle count

Question 4

What are the most useful investigations for women?

Answer 4

Ovarian reserve assessment:
day 2-3 FSH, LH, oestradiol, AMH
pelvic ultrasound and antral follicle count

Question 5

Which work up tests the tubal patency?

Answer 5

HSG and hystero contrast sonography

Question 6

Which infertility work up is for the male?

Answer 6

semen analysis: count, motility, abnormal forms, volume

Question 7

What are the effects of clomiphene with metformin or placebo on live birth rates?

Answer 7

Clomiphene alone results in highest live birth rate. No benefit combining with Metformin. clomiphene superior to metformin.