Female infertility

Question 1

3 issues

Answer 1

Ovulation disorder - PCOS (25%)
Tubal factors - damages cilia (20%)
Uterine factors - cancer (10%)

Question 2

Endometriosis

Answer 2

Progressive condition characterised by the growth of the endometrium into areas outside the uterus e.g. in the ovaries

Question 3

Endometriosis affects..

Answer 3

10-15% of women around the reproductive age (Parasar et al., 2017)

Question 4

Percentage of women infertile due to endometriosis

Answer 4

30-50% (Bulletti et al, 2010)

Question 5

Theory of endometriosis

Answer 5

Epigenetic changes

Question 6

Dyson et al 2014 research

Answer 6

Mapped genome difference in DNA methylation between healthy and endometriotic
Higher levels of GATA2 and lower GATA6 methylation levels

Question 7

Epigenetic changes facilitate..

Answer 7

Progesterone resistance and disease progression indicated this an integral component

Question 8

Epigenetic changes cause what to reduce fertility

Answer 8

Tubal blockage preventing egg moving down fallopian tube
Due to such inflammation physical symptoms alongside fertility may be seen
Lower back pain and dyspareunia

Question 9

If suspected endometriosis

Answer 9

History of female
Menstrual history e.g. heavy periods
Physical examination 
Diagnosed using laparoscopy 
HSG test may also be used for tubal blockages, radiologic procedure

Question 10

Laparoscopy

Answer 10

Invasive tool

Question 11

Ciliopathies

Answer 11

Problems with cilia motility within uterine tubes, impairs effective transport of the ova

Question 12

Assessment for ciliopathies

Answer 12

History

Tubal function test

Question 13

Disease that causes ciliopathies

Answer 13

Primary Ciliary Dyskinesia (PCD)

Question 14

Primary Ciliary Dyskinesia (PCD)

Answer 14

Characterised by abnormal motile cilia due to changes in cilia ultrastructure

Question 15

Prevalence of PCD

Answer 15

1 in 10,000

Question 16

Research by Lewis et al 2016 for PCD

Answer 16

Mutation in Growth Arrest Specific 8 (GAS8) is a cause

Study in mice

Question 17

Normal motile cilia

Answer 17

Coordinate movement

Mutations shown to correlate with clinical presentation of PCD

Question 18

Diagnosis of PCD

Answer 18

Female history 
Physical examination (breathing problems)
Tubal function test to assess quality of cilia 
Genetic testing as autosomal-recessive disorder (Lucas et al 2014)

Question 19

Abnormal mucus in cervix ..

Answer 19

Inhibiting sperm penetration

Question 20

Abnormal levels of mucus may be observed in physical examination clear diagnosis requires…

Answer 20

Postcoital test (aka Sims test)
Determine cervical function to assess if sperm is able to penetrate and survive in mucus

Question 21

Postcoital/ Sims test

Answer 21

Scheduled for 2 days after ovulation
Assessment of mucus is take 8-12Hrs after mucus removal
Poor result indicates that abnormal mucus present

Question 22

Problems with postcoital/ sims test

Answer 22

Lack validity

No predictive value in determining fertility problems (NICE 2016) lead to further tests (Oei et al 1998)