Fertility

Question 1

What % of couples will conceive within a year of regular unprotected sex?

Answer 1

85%

Question 2

When should referral and investigation of infertility be initiated?

Answer 2

After a couple has been trying to conceive for 12 months

6 months if the woman is older than 35

Question 3

What are the typical causes of infertility?

Answer 3

Sperm problems
Ovulation problems

Tubal problems
Uterine problems

Unexplained/Mix

Question 4

What general advice should be given to couples trying to conceive?

Answer 4

Woman should be taking 400mcg folic acid/day

Healthy BMI

Avoid smoking/excessive alcohol

Have intercourse 2-3 times a week

Question 5

What investigations can be performed for infertility?

Answer 5

BMI
Semen analysis
Serum LH/FSH
Serum progesterone
Anti-Mullarian hormone
USS pelvis
Hysterosalpingoram
Laparoscopy and dye test

Question 6

What is a hysterosalpingogram?

Answer 6

Type of scan used to assess shape of uterus and patency of fallopian tubes

Small tube is inserted into cervix, contrast fills uterus and Fallopian tubes with x-ray images taken

Tubal cannulation can also be undertaken to open closed tubes

Question 7

As well as being diagnostic, hysterosalpingograms are…

Answer 7

Therapeutic and increase the rate of conception

Question 8

What risk is associated with a hysterosalpingogram?

What precautions/investigations should be performed before?

Answer 8

Infection

Prophylactic antibiotics
Chlamydia/gonorrhoea testing

Question 9

What is the function of laparoscopy and dye test?

Answer 9

Dye is inserted into the uterus, should be seen entering Fallopian tubes and spilling out the ends

Allows you to assess patency of Fallopian tubes and look for any endometriosis or pelvic adhesions

Question 10

How does clomifene work in the treatment of infertility?

Answer 10

Stimulates ovulation

Blocks oestrogen receptors in brain —> reduced -ve feedback —> increased GnRH, LH and FSH —> ovulation

Question 11

What does semen analysis test?

Answer 11

The volume and quality of the sperm and semen

Question 12

What factors may affect the result of semen analysis?

Answer 12

Hot baths
Tight underwear
Smoking
Alcohol
Raised BMI
Caffeine

Question 13

What is the normal semen volume?

Answer 13

> 1.5ml

Question 14

What is the normal pH of semen?

Answer 14

> 7.2

Question 15

What is the normal concentration of sperm in semen analysis?

Answer 15

> 15 million/ml

Question 16

What is the normal total number of sperm in semen analysis?

Answer 16

> 39 million/sample

Question 17

What is the normal % motility of sperm in semen analysis?

Answer 17

> 40% mobile

Question 18

What is the normal vitality of sperm in semen analysis?

Answer 18

> 58%

Question 19

What is the normal percentage of normal sperm in semen analysis?

Answer 19

> 4%

Question 20

What is rough success rate of IVF (in vitro fertilisation)?

Answer 20

30%

Question 21

What is the general process of IVF (in vitro fertilisation)?

Answer 21

Egg fertilised in the lab and injected into the uterus

Question 22

What is ovarian hyperstimulation syndrome?

Answer 22

Complication of infertility treatment that promotes the development of eggs in the ovaries

Causes release of oestrogens, progestogens and vascular endothelial growth factors

Question 23

How serious is ovarian hyperstimulation syndrome?

What is the management?

Answer 23

Ranges from mild - critical (e.g. ARDS, thromboembolism, ARDS)

Supportive, treat complications and admit to ICU in severe/critical cases