Exam 3 - LOs

Question 1

Define infertility

Answer 1

Inability to achieve pregnancy after 12 months of unprotected sex

Question 2

List potential causes of infertility for females

Answer 2

• Ovulatory dysfunction
• Tubal factor
• Endometriosis
• Maternal age
• PCOS
• Luteal phase defect
• Toxic insult
• Uterine abnormality
• Genetic disorder
• Infection

Question 3

List potential causes of infertility for males

Answer 3

• Testicular injury
• Primary testicular failure
• Varicocele
• Infection
• Impotence
• Spinal cord injury

Question 4

Explain the reasoning behind checking a female’s
Day 3 FSH and her AMH

Answer 4

FSH is lowest on day 3; high FSH levels on day 3 indicate diminished ovarian reserve and lower fertility potential.
- AMH can be measured at any point and it indicates the quantity of developing eggs in the ovaries; higher AMH reflects better ovarian reserve.

(Day 3 FSH > 10mlU/mL and AMH <0.8ng/mL indicates poor prognosis)

Question 5

Describe a hysterosalpingogram (HSG) and what
information is obtained from the test

Answer 5

HSG is an X-ray with contrast dye to determine whether tubes are open or blocked

Question 6

Explain why IVF only accounts for about 3% of
infertility treatment

Answer 6

Most infertility cases (85-90%) are treated with conventional medicine therapies such as dietary modification, exercise, or surgery.

Question 7

Describe the steps involved in IUI

Answer 7

1. Ovarian stimulation
2. Transvaginal ultrasound
3. Trigger ovulation
4. Insemination

Question 8

Explain the mechanism of action for clomiphene
citrate in ovarian stimulation

Answer 8

• Estrogen antagonist
• Blocks (-) feedback by estradiol and thud stimulates FSH and LH secretion
• May change quality of cervical mucus and reduce endometrial proliferation.

Question 9

Explain the mechanism of action for letrozole (femara) in ovarian stimulation

Answer 9

• Aromatase inhibitor
• Prevents ovarian and peripheral conversion of androgens to estrogens- Lower estradiol permits more FSH and LH secretion

Question 10

Explain the mechanism of action for FSH or hMG in ovarian stimulation

Answer 10

Directly stimulates follicle development
- Low doses stimulate growth of 2-3 follicles
- Some brands are purified from urine of post-menopausal females (hMG)

Question 11

Distinguish between an agonist and antagonist

Answer 11

Agonist: stimulates action
Antagonist: inhibits action

Question 12

Explain (rather than simply describe) the ideal
conditions for triggering ovulation for IUI

Answer 12

Female: <45 years old, open tubes
Males: >10 million sperm/ml, >35% motility

Question 13

Explain why ovarian stimulation resulting in
simultaneous development of multiple follicles (for
IUI or IVF) does not deplete future follicle reserve

Answer 13

FSH and LH act to recruit and stimulate growth of multiple follicles during the cycles but does not deplete the reserve because ovaries naturally contain thousands of follicles.
The stimulation accelerates maturation of follicles that would have otherwise been selected naturally over multiple menstrual cycles.

Question 14

Explain how and when ovulation is triggered for
IUI

Answer 14

Ovulation occurs on day 14, between follicular phase and luteal phase for IUI. Mimic LH surge to stimulate ovulation, typically with hCG.