Fertility and Infertility

Question 1

How long is an egg viable for?

Answer 1

24 hours after ovulation

Question 2

How long can spermatozoa survive for after ejaculation?

Answer 2

5 days post ejaculation

Question 3

What are the key elements that determine fertility?

Answer 3

Production of normal sperm and eggs
Ability of sperm to transverse female tract, undergo capacitation and penetrate and fertilise the oocyte
Implantation of embryo in correct location

Question 4

What is fertility

Answer 4

A measure of actual outcome of the reproductive process i.e. no of children born to an individual

Question 5

What is fecundability?

Answer 5

Probably of conceiving each month (monthly fertility rate) for an individual/population

Question 6

What is fecundity?

Answer 6

Combination of fertility and fecundability

Measure of the ability to conceive and produce a live birth

Question 7

What is infertility?

Answer 7

Inability to conceive after a period of unprotected intercourse OR the inability to carry a pregnancy to term
NICE - define as failure to get pregnant for 2 year but not necessarily due to true inferility

Question 8

What is subfertility?

Answer 8

State of reduced fertility but not absolute inability to have live birth

Question 9

Where does the cause of infertility usually lie?

Answer 9

Around 50:50 male and female but sometime combination of two

Question 10

Summarise factors that can lead to female infertility

Answer 10

Ovulation disorder (around 40%)
Issues with: implantation, growth and development
Tubal damage/obstruction
Endometriosis
Uterine abnormalities

Question 11

How can we diagnose female infertility?

Answer 11

Blood analyses - hormonal abnormalities
Laproscopic surgery
Hysterosalpingography (radiography) - determine patency of uterine tubes
Ovarian reserve test - Day 21, progesterone
AMH test - Day 2-4, LH+FSH

Question 12

What will ovulation disorder result in?

Answer 12

Issues in menstrual cycle e.g. primary/secondary amenorrhea, oligomenorrhea or anovulatory cycle
- Associated with stress (can be treated with placebo), obesity, strenuous exercise, anorexia nervosa and drug use

Question 13

What can cause ovulation disorder?

Answer 13

Stress (can be treated with placebo), obesity, strenuous exercise, anorexia nervosa and drug use
Sometimes failure of neuroendocrine system at puberty
Idiopathic ovarian failure
PCOS
Endocrinologically normal anovulatory cycles - Luteinised unruptured follicle syndrome (LUF)
Abbreviated luteal phase

Question 14

Idiopathic ovarian failure

Answer 14

End organ insensitivity = gonadotrophin secretion normal but insufficient to support normal cycle
Oestrogen levels fail to rise as ovaries are insensitive to LH and FSH so follicles fail to mature - many small follicle

Question 15

Endocrinologically normal anovulatory cycles

Answer 15

Oocytes are poor quality/deficient and never mature -> Luteinised unruptured follicle syndrome (LUF)

Question 16

PCOS

Answer 16

Associated with increase LH and androgens, mild increase in follicular phase

Question 17

Abbreviated luteal phase

Answer 17

Reduced progesterone -> poor luteinisation of follicles

Question 18

What are the disorder of the female tract causing infertility?

Answer 18

Tubal obstruction
- usually secondary to pelvic infection, increases in incidence after STIs and can be caused by post-abortal/post-pregnancy sepsis
- infection -> loss of cilia on intraluminal cell and scaring and adhesion -> impaired oocyte and sperm transport
Endometriosis
- endometrial tissue growth invades ectopic sited e.g. oviduct, ovary, peritoneal cavity -> scaring and adhesion

Question 19

Tubal obstruction

Answer 19

Usually secondary to pelvic infection, increases in incidence after STIs and can be caused by post-abortal/post-pregnancy sepsis
infection -> loss of cilia on intraluminal cell and scaring and adhesion -> impaired oocyte and sperm transport

Question 20

Endometriosis

Answer 20

Endometrial tissue growth invades ectopic sited e.g. oviduct, ovary, peritoneal cavity -> scaring and adhesion

Question 21

What can be the cause of maternal problems causing female infertility?

Answer 21

Cervical incompetence (cervix dilates to reveal pregnancy), implantation defects, autoimmune disease, immunological incompatibility with foetus (ABO/rhesus)

Question 22

When can biological pregnancy be tested?

Answer 22

Presence of hCG detected in blood and urine 18-30 days after initiation of last period

Question 23

When can a clinical pregnancy be detected?

Answer 23

Ultrasound first detects at 5 weeks

Foetal heart beat can be detected at 7 weeks