Fertility Flashcards
Low risk dosing (healthy women) of folic acid during conception?
400 micrograms folic acid daily from before TTC until the12th week of pregnancy
Criteria for high dose folic acid during conception?
- Either partner has a NTD
- Family history of NTD
- Previous pregnancy affected by a NTD
- OBESITY (BMI 30+)
- On anti-epileptic medication
- Diabetic
- Coeliac disease
- Thalassemia trait
What dose of folic acid should be given to women at high risk of NTD?
5mg daily from before TTC until the 12th week of pregnancy
Which are considered the safest / least teratogenic anti-epileptic medications in women of child-bearing age?
Lamotrigine
Levetiracetam
Carbamazepine
(Should ideally aim for monotherapy to minimize the congenital defect risk + all should be on 5mg Folic Acid well before conception)
What is the baseline risk of congenital defects in women taking anti-epileptic medication compared to baseline population?
Risk of congenital defect = 3-4% if on anti-epileptic medication
Baseline population risk = 1-2%
Which type of fibroid IS associated with impairing IVF outcomes and should be excised prior to IVF?
SUBMUCOSAL FIBROIDS
Mucosal Mess Up IVF
(intramural unclear, subserosal no effect)
What is the process for testing male sperm quality/number during fertility investigations?
If 1st sample normal -> no need for a repeat
If 1st sample abnormal -> repeat at 3 months (if pt very anxious or severely abnormal 1st result eg azoospermia or severe oligospermia can do at 2-4 wks)
What is a normal sperm count?
15 - 200 million sperm per ml of semen
What sperm count is generally accepted for IUI?
As long as the sperm count is 5 million or above with reasonably motile sperm then IUI can be considered
In what circumstances is laparoscopy with dye test preferred as a test of tubal patency over hysterosalpingogram?
If patient has risk factors for tubal adhesions / pathologies (eg prev surgery / prev PID) then better to laparoscopy with tubal patency test because then can do further interventions at the same time (eg adhesionolysis)
What % of women will ovulate after clomiphene treatment?
80% will ovulate on clomiphene
What investigation should be performed in men with severe oligospermia or azoospermia in 2x samples?
A karytype to look for Klinefelters (XXY)
what are the chances of successful pregnancy after reversal of female sterilisation in women with otherwise nil other known fertility issues?
Pregnancy after female sterililsation reversal ranges from 50-70% depending on female age
what are the various grades of severity of OHSS?
Mild - ovary size <8cm, mild abdominal pain and bloating
Moderate - ovary size 8-12cm, moderate abdo pain with N+V, ascites on USS
Severe - ovary size >12cm, clinical ascites, oliguria, haematocrit > 45%, low serum protein
Critical - Tense ascites or large hydrothorax, haematocrit >55%, oliguria or anuria, venous thromboembolism, acute respiratory distress syndrome
What are the normal, borderline and abnormal levels of day 21 progesterone as a marker of ovulation?
Should be taken 7 days prior to next expected period (ie day 21 of 28 day cycle)
- if >30 = indicates ovulation has occured
- if 16 - 30 = borderline -> repeat
- if < 16 = low -> repeat and if remains low refer to specialist
What general fertility advice should be given to all couples trying to conceive?
Folic acid 400 micrograms daily
BMI 19-30
Stop smoking
Regular sexual intercourse every 2-3 days
What is the baseline fertility of couples?
Couples where the woman is <40, not on contraception and having regular intercourse:
- 80% will conceive in the 1st year
- additional 10% will conceive in the 2nd year (90% cumulatively)
Women < 40 undergoing IUI:
- 50% will conceive within the first 6 cycles
- by 12 cycles, 75% will have conceived
What is the difference between sperm motility and progressive-motility
Progressive motility = sperm that move forward or in large circles
Motile sperm - are just moving in tight circles or don’t make much progression
What markers for ovarian reserve are acceptable and what levels of each are used as cut-offs to identify low v high responders?
1) Total antral follicle count (= no of follicles 5mm or less, measured between day 2-5 of cycle via TV USS)
4 or less = marker of low responder
16 or more = marker of high responder
2) AMH
<5.4 pmol/L = low responder
25+ = high responder
3) FSH
> 8.9 IU/L= low responder
<4 IU/L high responder
What are the W.H.O parameters for a normal sperm analysis?
Normal volume: 1.5ml+ of ejaculate
Normal pH: 7.2+
Normal sperm concentration: 15 million sperm/ml +
Normal total sperm: 39 million/ejaculate +
Normal motility (40%+ total motility, 32%+ progressive motility)
Normal morphology: 4%+
Vitality: 58% + should be alive
What is the definition of severe oligospermia?
<5 million sperm/ml
Why should clomiphene not be used for > 6 cycles
Increased risk of ovarian cancer
What is the chance of miscarriage following uterine artery embolisation for fibroids?
60-70%
Which 2x pregnancy complications are increased in women who experienced OHSS?
Prematurity
Pre-eclampsia
