Fertility

Question 1

When should investigation or referral for infertility be initiated

Answer 1

When a couple has been trying to conceive unsuccessfully for 12 months
Reduced to 6 months if a woman is over 35

Question 2

Causes of infertility

Answer 2

Sperm problems
Ovulation problems
Tubal problems
Uterine problems
Unexplained

Question 3

General advice for fertility

Answer 3

Woman taking 400mcg folic acid daily
Maintain healthy BMI
Avoid smoking & excessive alcohol
Reduce stress
Aim for intercourse every 2-3 days
Avoid timing intercourse

Question 4

Female hormone tests to investigate infertility

Answer 4

Serum LH & FSH on days 2-5 of cycle
Serum progesterone on day 21 of cycle
Anti-Mullerian hormone
TFTs
Prolactin

Question 5

Management on anovulation

Answer 5

Weight loss
Clomifene
Letrozole
Gonadotrophins
Ovarian drilling
Metformin

Question 6

Management of tubal factors causing infertility

Answer 6

Tubal cannulation during hysterosalpingogram
Laparoscopy to remove adhesions or inappropriate endometrial tissue
IVF

Question 7

Management of sperm problems affecting fertility

Answer 7

Surgical sperm retrieval
Surgical correction of vas deferens obstruction
Intra-uterine insemination
Intracytoplasmic sperm injection
Donor insemination

Question 8

Factors affecting semen analysis

Answer 8

Hot baths
Tight underwear
Smoking
Alcohol
Raised BMI
Caffeine

Question 9

What is assessed in semen analysis

Answer 9

Semen volume
Semen pH
Sperm concentration
Total number of sperm per sample
Motility of sperm
Vitality of sperm
% of normal sperm

Question 10

Pre-testicular causes of male infertility

Answer 10

Pathology of pituitary gland or hypothalamus
Stress
Hyperprolactinaemia
Kallman syndrome

Question 11

Testicular causes of male infertility

Answer 11

Mumps
Undescended testes
Trauma
Radiotherapy
Chemotherapy
Cancer
Klinefelter syndrome
Y chromosome deletions
Sertoli cell only syndrome
Anorchia

Question 12

Post-testicular causes of male infertility

Answer 12

Damage to testicle or vas deferens
Ejaculatory duct obstruction
Retrograde ejaculation
Scarring from epididymitis
Absence of vas deferens
Young’s syndrome

Question 13

Steps involved in IVF

Answer 13

1 - Suppression of natural menstrual cycle
2 - Ovarian stimulation
3 - Oocyte collection
4 - Insemination
5 - Embryo culture
6 - Embryo transfer

Question 14

Complications of IVF

Answer 14

Failure
Multiple pregnancy
Ectopic pregnancy
Ovarian hyperstimulation syndrome

Question 15

What is used to stimulate ovaries during IVF

Answer 15

hCG

Question 16

Risk factors for ovarian hyperstimulation syndrome

Answer 16

Younger age
Lower BMI
Raised anti-Mullerian hormone
Higher antral follicle count
PCOS
Raised oestrogen levels

Question 17

Prevention of ovarian hyperstimulation syndrome

Answer 17

Monitoring of serum oestrogen & US follicles
Use of GnRH antagonists
Lower doses of gonadotrophins
Lower doses of hCG injection
Use of LH instead of hCG

Question 18

Features of ovarian hyperstimulation syndrome

Answer 18

Abdominal pain & bloating
Nausea & vomiting
Diarrhoea
Hypotension
Hypovolaemia
Ascites
Pleural effusions
Renal failure
Peritonitis
Prothrombic state

Question 19

Management of ovarian hyperstimulation syndrome

Answer 19

Oral fluids
Monitoring of urine output
LMWH
Ascitic fluid removal
IV colloids