Fertility Treatment

Question 1

What is primary infertility?

Answer 1

Pregnancy has never occurred

Question 2

What is secondary infertility?

Answer 2

One/both members of the couple have previously conceived, but are unable to conceive again after 1 year of trying

Question 3

What is the success rate for IVF and donor insemination?

Answer 3

IVF = 22%
DI = 14%

Question 4

What is prostatitis?

Answer 4

Inflammation of the prostate gland

Question 5

What is orchitis?

Answer 5

Inflammation of the testicles

Question 6

What is retrograde ejaculation?

Answer 6

Semen enters the bladder instead of the penis during ejaculation

Question 7

What hormone is tested in women to assess ovarian stimulation?

Answer 7

Serum progesterone

Question 8

What is endometriosis?

Answer 8

Endometrium grows outside the uterus and attaches to other organs (e.g. fallopian tubes, ovaries)

Question 9

What is the management for Endometriosis?

Answer 9

• Surgical ablation
• Consider ovarian stimulation (IUI)
• In severe cases, consider ART

Question 10

What does ART stand for?

Answer 10

Assisted Reproductive Technology

Question 11

What are the types of ART?

Answer 11

• Donor insemination
• Double embryo transfer
• Elective single embryo transfer
• IVF
• Uterine embryo transfer
• Gamete intra-fallopian transfer
• Zygote intra-fallopian transfer
• Intracytoplasmic sperm injection
• Assisted hatching

Question 12

What is gamete intra-fallopian transfer?

Answer 12

Retrieval of eggs and transfer of unfertilised eggs and sperm into the fallopian tubes by laparoscopy

Question 13

What is zygote intra-fallopian transfer?

Answer 13

Retrieval of eggs and transfer of fertilised eggs into the fallopian tubes by laparoscopy

Question 14

What is assisted hatching?

Answer 14

Making a microscopic opening in the embryo wall to facilitate hatching of the embryo

Question 15

What is step 1 of IVF?

Answer 15

Down-Regulation:

• Suppress natural hormone cycle by giving GnRH to inhibit premature rise of LH
• This prevents follicles rupturing before egg collection
• Daily injection for 2 weeks

Question 16

What is step 2 of IVF?

Answer 16

Boosting Egg Supply:

- FSH given as daily injection for 12 days

Question 17

What is step 3 of IVF?

Answer 17

Ultrasound:

• Used to determine right time for egg collection based on maturity of follicles
• Given trigger injection of hCG 36 hours before egg collection to stimulate final maturation of oocytes

Question 18

What is step 4 of IVF?

Answer 18

Egg Collection:

• Procedure under sedation
• USS used for guidance
• Can cause cramping and small amount of PV bleed
• Given progesterone injection to stimulate endometrial thickening

Question 19

What is step 5 of IVF?

Answer 19

Fertilisation:

• Eggs fertilised in lab and left for 16-20 hours to fertilise
• Grown for 1-2 days

Question 20

What is step 6 of IVF?

Answer 20

Egg Transfer:

• Usually 1 or 2 eggs
• Remaining eggs can be frozen for future use
• 10/7 of progesterone to maintain pregnancy

Question 21

What is obstructive azoospermia?

Answer 21

Semen containing no spermatozoa despite normal spermatogenesis

Question 22

What is non-obstructive azoospermia?

Answer 22

Semen containing no spermatozoa due to failure of spermatogenesis

Question 23

At what age are women able to have IVF treatment?

Answer 23

18-43

Question 24

What is a Hycosy?

Answer 24

Procedure where fallopian tubes are filled with dye to detect problems with eggs travelling - should see dye pooling in ovaries

Question 25

What must be done before any fertility treatment takes place?

Answer 25

Testing for infectious diseases

Question 26

What is FSH given for?

Answer 26

Stimulates ovaries to produce more follicles

Question 27

What is Clomid given for?

Answer 27

• Stimulates ovaries to produce more eggs

- 1st treatment for PCOS and used for irregular/late periods

Question 28

What is the risk of giving women Clomid?

Answer 28

Overdevelopment of follicles, leading to a risk of multiple pregnancy

Question 29

What is Metformin given for?

Answer 29

• Decreases insulin levels

- Some women with PCOS can’t ovulate properly due to abnormal insulin levels

Question 30

What are Gonadotrophins given for?

Answer 30

• Women with PCOS who have tried Clomid but still experiencing issues
• Stimulates egg production

Question 31

What are Bromocriptine and Cabergoline given for?

Answer 31

• Used by women with hyperprolactinaemia

- Increases levels of dopamine in the brain which reduces prolactin levels

Question 32

How does hyperprolactinaemia affect fertility?

Answer 32

Too much prolactin results in decreased oestrogen levels which causes difficulty ovulating

Question 33

Why might men be given Gonadotrophins?

Answer 33

To increase sperm production

Question 34

Until what age can women receive donor eggs?

Answer 34

50 years old

Question 35

What is PGS?

Answer 35

Pre-implantation Genetic Screening:

• testing embryo DNA for chromosomal abnormalities
• not available on NHS

Question 36

What is PGD?

Answer 36

Pre-implantation Genetic Diagnosis:

• testing embryo DNA for specific genetic abnormalities
• e.g. if FHx Down’s

Question 37

What is PTT?

Answer 37

Pre-implantation Tissue Typing:

• determines tissue type to aid transfusion of stem cells from a tissue-matched donor as part of IVF
• helps children with blood disorders

Question 38

What is OHSS?

Answer 38

Ovarian Hyperstimulation Syndrome:

- ovaries over-respond to drugs

Question 39

What are the symptoms of OHSS?

Answer 39

• Bloating
• Abdominal discomfort
• N+V
• Reduced urine output

Question 40

What is the treatment for OHSS?

Answer 40

• Reduce drug dose
• Avoid intercourse for 7 days
• Extreme cases = stop treatment