Fertility

Question 1

What is the normal fertility rate?

Answer 1

80% by 6 months

90% by 12 months

Question 2

What are the HPO (low FSH) causes of infertility?

Answer 2

• Low weight
• Stress/Severe illness
• High physical activity
• Pituitary tumour
• Infiltrative:e.g. sarcoid,
haemochromatosis
• Genetic:egKallmannsyndrome

Question 3

What are the ovarian (high FSH) causes of infertility?

Answer 3

• Iatrogenic(chemo/radiation)
• Autoimmune(SLE, RA)
• Genetic(FragileX, XO, family history)
• Idiopathic
• Physiological(Age>45)

Question 4

What are the anatomical causes of infertility?

Answer 4

Congenital
• Mullerian abnormalities
• DSD

Acquired
• Compromised tubal patency
• Endometriosis
• Fibroids

Question 5

What is the most common cause of infertility?

Answer 5

Obesity and PCOS

Question 6

What are the male causes of infertility?

Answer 6

Sperm
Azoospermia 
Oligozoospermia 
Motility 
Morphology

Modifiable
Hypo-gonadism 
Smoking
Vasectomy 
Varicocoele
Anabolic steroid abuse

Genetic
Klinefelters
CF - vas deferens
Y chromosome AZF

Question 7

How does IVF work?

Answer 7

• Super-ovulation (FSH/GnRH suppression)
• Induce oocyte maturation
• Collect Oocytes (US guided TV needle aspiration procedure)
• Fertilization in vitro +/- ICSI
• Embryo culture
• Embryo transfer
• Vitrification of excess embryos

Question 8

What is ovarian hyperstimulation syndrome?

Answer 8

Multiple corpus luteums causes fluid inbalance

Question 9

How do you investigate for egg reserve? Why do/don’t it?

Answer 9

Measure serum anti-Mullarian hormone

To target the amount of stimulation required for super-ovulation

In women who are 45 and above - won’t affect management