Fertility

Question 1

List some general causes for sub fertility

Answer 1

Increased age
Body weight too high or too low
Smoking
High alcohol intake
Drugs (chemotherapy, NSAIDs, cimetidine, sulphasalazine)
Low frequency of intercourse

Question 2

What is the definition of ‘subfertility’?

Answer 2

Failure to conceive after 1 year of regular, unprotected sexual intercourse

Question 3

Which hormone test can be done to indicate whether ovulation has occurred in the investigation of sub fertility? When must this be carried out?

Answer 3

Mid-luteal progesterone, taken 7 days before menstruation (regardless of cycle length) i.e. Day 21 in a 28 day cycle, day 28 in a 35 day cycle.

Question 4

List some ways to treat sub fertility

Answer 4

Lifestyle factors: Reduce weight, smoking, caffeine intake, alcohol
Correct thyroid problems
Correct raised prolactin
Treat PCOS - Clomifene
Recombinant FSH - Helps to develop the follicles which can be monitored and ovulation stimulated when they reach adequate size
Ovarian drilling

Question 5

What is intrauterine insemination?

Answer 5

Sperm is injected directly into the uterine cavity

Question 6

What are the 4 stages of IVF?

Answer 6

Follicular development
Ovulation and egg collection
Fertilisation and culture
Embryo transfer

Question 7

What is ICSI?

Answer 7

Intracytoplasmic sperm injection - A single sperm is injected directly into a single egg. May be done as part of IVF.

Question 8

What is the approximate success rate of IVF?

Answer 8

Varies! Usually about 25% per cycle but varies, especially with age

Question 9

Describe the process of IVF

Answer 9

Follicular develop - 2/52 of daily gonadotrophin hormone injections to stimulate follicular development. Drug given alongside to prevent LH surge to stop premature ovulation.
Ovulation and egg harvesting - Once an appropriate number of follicles present, a single HCG or LH dose given to stimulate maturation of the oocyte and about 36 hours later this is harvested under sedation.
Fertilisation - The egg is cultured with washed sperm in a culture medium in vitro
Implantation - Embryo(s) is re-introduced back into the uterus. Pregnancy test advised about 2/52 later.

Question 10

List some complications of IVF

Answer 10

Multiple pregnancy (in as many as 25% of IVF pregnancies)
Ovarian hyperstimulation syndrome
Complications of pregnancy, including ectopic pregnancy

Question 11

What is ovarian hyperstimulation syndrome?

Answer 11

Ascites, nausea, vomiting, grossly enlarged multi follicular ovaries, pulmonary oedema. Caused by hyper stimulation of the ovaries during IVF. Women need hospital admission.