Infertility

Question 1

Infertility is defined in what 2 ways?

Answer 1

• > 12 months of regular unprotected intercourse or donor insemination in women <35 yo
• > 6 months of regular unprotected intercourse or donor insemination in women >35 yo

Question 2

What is the difference between primary and secondary infertility?

Answer 2

• primary = in a patient/couple who have never had a pregnancy
• secondary = in a patient/couple that has had a pregnancy before

Question 3

What is the most important factor impacting fertility?

Answer 3

• maternal age

Question 4

What is the impact of BMI on fertility?

Answer 4

• fecundability decreases with increasing BMI

Question 5

How to do you optimize natural conception?

Answer 5

• encourage use of ovulation predictor kits and time intercourse (1-2 days preceding ovulation)

Question 6

Who should infertility patients see for further evaluation?

Answer 6

• reproductive endocrinologist

Question 7

Which of the following patients meet the diagnostic criteria for PRIMARY infertility?

1. A 29-year-old who has been unable to conceive after 10 months of unprotected intercourse.
2. A 31-year-old who has been unable to conceive after 10 months of donor inseminations.
3. A 35-year-old who has been unable to conceive after 6 months of unprotected intercourse with a history of a miscarriage in the first trimester last year.
4. A 37-year-old who has been unable to conceive after 6 months of unprotected intercourse.

Answer 7

4. A 37-year-old who has been unable to conceive after 6 months of unprotected intercourse.

Question 8

What is the best initial evaluation of the etiology of infertility in a 25-year-old female who has been trying to conceive for > 12 months?

a. Endometrial biopsy
b. Hysterosalpingogram (HSG)
c. Ovulation predictor kits
d. Basal body temperature charts

Answer 8

c. Ovulation predictor kits

Question 9

The most important prognostic factor affecting fertility is:

a. Day 3 FSH and estradiol levels
b. Female age
c. Sperm count
d. BMI

Answer 9

b. Female age

Question 10

What is the difference between fecundity, fertility, and fecundability?

Answer 10

• fecundity = biologic capacity to reproduce
• fertility = demonstrated fecundity
• fecundability = probability of achieving pregnancy during one menstrual cycle

Question 11

What are the 4 ovarian evaluation tests available in clinic?

Answer 11

• antral follicle count (AFC)
• anti-mullerian hormone (AMH)
• Day 3 Labs (FSH, Estradiol)
• Clomiphene citrate challenge test (CCCT)

Question 12

A high antral follicle count (AFC) may indicate what condition?

Answer 12

PCOS

Question 13

What is a normal finding on day 3 labs (FSH, estradiol)?

Answer 13

• FSH and estradiol should be LOW

Question 14

How is the clomiphene citrate challenge test (CCCT) done?

Answer 14

• measure Day 3 FSH and estradiol and then give Clomid on days 5-9 and then remeasure FSH and estradiol on day 10

Question 15

What imaging test is most often used when examining the uterus?

Answer 15

hysterosalpingogram (HSG)

Question 16

What is the corner stone work up test done for males?

Answer 16

sperm analysis