Gynaecology: Fertility

Question 1

What are the key investigation for a woman presenting with infertility?

Answer 1

1. Day 21 progesterone aka. mid-luteal progesterone
   - identifies if woman is ovulating
   - < 16 - repeat, if persistently low refer
   - 16-30 - repeat
   - > 30 - woman is ovulating
2. Hormone profile - FSH, LH, prolactin, testosterone

Question 2

What is the definition of primary ovarian insufficiency?

Answer 2

Depletion of ovarian activity < 40 yo

Question 3

What are some examples of secondary ovarian insufficiency?

Answer 3

1. PCOS
2. Hyperprolactinaemia
3. Hypothalamic causes e.g. hypogonadotrophic hypogonadism, over-exercise, systemic illness
4. Hypopituitarism - tumour, trauma, surgery

Question 4

What are the differences in FSH, LH and oestrodiol between (a) ovarian insufficiency (b) hyperprolactinaemia (c) hypothalamic causes (d) PCOS

Answer 4

Ovarian insufficiency - Low oestrodiol
- High FSH + LH

Hyperprolactin

• Low FSH + LH
• Low oestrodiol

Hypothalamic

• Low FSH + LH
• Low oestrodiol

PCOS

• Low FSH or normal
• High LH or normal
• High oestrogen or normal

Question 5

How can you treat hyperprolactin infertility?

Answer 5

Dopamine agonists

- Bromocriptine or Carbogaline

Question 6

What is the 1st line treatment for infertility?

Answer 6

Lifestyle and advice

• Healthy diet
• Reduce weight
• Reduce alcohol
• Stop smoking and abusing drugs
• Avoid timetabled sex
• Vitamin D and Folic acid

Question 7

What is the 1st line medication for infertility?

Answer 7

Clomiphene

Question 8

What is the treatment for PCOS?

Answer 8

1. Life style and advice

2. Clomiphene and Metformin

Question 9

What is a complication of IVF?

Answer 9

Ovarian hyperstimulation syndrome (OHSS)