Infertility

Question 1

What is infertility?

Answer 1

Inability to conceive over a 12 month period despite exposure to regular , unprotected intercourse.

Question 2

What can naturally cause a decrease in fertility?

Answer 2

Increasing age

Question 3

How does age have an effect on fertiltiy?

Answer 3

Decline in the number of eggs

Decline in the ability of cell division

Question 4

What does natural conception depend on in terms of the female?

Answer 4

• Functioning hormonal axis and gonads
• Ovarian reserve
• Regular ovulation

Question 5

What does natural conception depend on in terms of fertilisation?

Answer 5

Egg and sperm interaction
Patent fallopian tubes
Normal uterine cavity for implantation

Question 6

What lifestyle factors contribute to fertility?

Answer 6

• Age
• BMI
• Smoking
• Alcohol
• Recreational drug use
• Stress

Question 7

When would you refer a couple for infertiltiy?

Answer 7

No conception after one year of regular unprotected intercourse

Question 8

When would you refer a couple for infertility early?

Answer 8

Older than 35

Known cause for infertility

Question 9

What is primary infertility?

Answer 9

They have never had a pregnancy before

Or the man has never fathered a child

Question 10

What is Secondary infertility?

Answer 10

They have had a previous pregnancy in this or a previous relationship but can’t get pregnant in this one

Question 11

What is the most common cause of female infertility?

Answer 11

Ovulation dysfunction- A woman not releasing an egg regularly

Question 12

What are other possible causes of female infertility?

Answer 12

• Tubal factor (fallopian tube)
• Diminishing ovarian reserve
• Endometriosis
• Uterine factor

Question 13

What are male causes of infertility?

Answer 13

• Problem with producing hormones for sperm production
• Blockage of sperm transport
• Sperm production problems
• Erection or ejaculation problems

Question 14

What are the 4 things to investigate for infertiltiy?

Answer 14

Eggs available
Ovulation happening
Sperm available
Can the egg and sperm meet

Question 15

How would you test for the availability of eggs?

Answer 15

Blood test

Question 16

What would you look for in the blood to check for the availability of eggs?

Answer 16

FSH level

AMH level

Question 17

What is the most reliable test for egg availability?

Answer 17

AMH
(Anti-Müllerian hormone)

Question 18

When would you measure FSH?

Answer 18

Between day 1 and day 5 of the cycle

Question 19

When would you measure AMH?

Answer 19

Any point throughout the cycle

Question 20

What scan can you do for egg number?

Answer 20

Ultrasound scan

Question 21

What can an ultrasound scan tell you?

Answer 21

Antral Follicular count

Question 22

What is used to check if ovulation is happening?

Answer 22

D21 serum progesterone

Question 23

When should D21 serum progesterone be measured?

Answer 23

Day 21 of a 28-30 day cycle

Question 24

What level of progesterone would suggest satisfactory ovulation?

Answer 24

Progesterone more than 20nmol/l

Question 25

How would you check the sperm availability?

Answer 25

Semen analysis

Question 26

What should the concentration of the semen be?

Answer 26

About 15million/ml

Question 27

What should the volume of semen be?

Answer 27

1.5ml

Question 28

What 2 things are important for the egg and sperm to be able to meet?

Answer 28

Patent fallopian tube

Intercourse

Question 29

How would you check the patency of the fallopian tubes if there was no pelvic infection or gynaecological problem?

Answer 29

Hysterosalpingogram

Question 30

How would you check the patency of the fallopian tubes if there was a pelvic infection or gynaecological problem?

Answer 30

Laparoscopic dye test