Infertility

Question 1

What is infertility?

Answer 1

The inability of a couple to conceive after 12 months of regular, unprotected, sex.

Question 2

What is primary infertility?

Answer 2

A couple has never conceived together - either of the 2 can have children with another partner and still be classed as primary infertility.

Question 3

What is secondary infertility?

Answer 3

A couple have previously conceived together but cannot fall pregnant again.

Question 4

What is described as day 1 of the ovulatory cycle?

Answer 4

The first day of bleeding.

Question 5

What are the 2 phases of the menstrual cycle?

Answer 5

Follicular phase

Luteal phase

Question 6

Which phase of the menstrual cycle is always a consistent 14 day period?

Answer 6

Luteal phase

Question 7

How long should a normal period last?

Answer 7

3-8 days

Question 8

What is oligomenorrhoea?

Answer 8

A menstrual cycle lasting over 35 days.

Question 9

What is amenorrhoea?

Answer 9

Absence of menstruation

Question 10

What triggers ovulation?

Answer 10

The LH surge.

This occurs 35 hours before ovulation.

Question 11

What hormones control the first (follicular) phase of menstruation?

Answer 11

FSH and oestrogen

Question 12

Which hormone controls the second (luteal) phase of menstruation?

Answer 12

Progesterone

Question 13

What indicates ovulation is occuring as intended?

Answer 13

Progesterone level at day 21/1 week before period.

Question 14

Why is rubella vaccination of mother important?

Answer 14

As virus can cross the placenta, attacking the developing baby.

Results in severe abnormalities.

Question 15

What is azoospermia?

Answer 15

No sperm in semen sample.

Question 16

What is asthenozoospermia?

Answer 16

Poor semen swimming observed in semen sample.

Question 17

What is oligozoospermia?

Answer 17

Low sperm number observed in semen sample.

Question 18

What is teratozoospermia?

Answer 18

Poor sperm morphology in semen sample.

Question 19

What are the first-line tests for a couple with infertility issues?

Answer 19

Semen analysis

USS of women

Question 20

How does PCOS appear on USS?

Answer 20

Lots of dark circles - these are follicles. Patient has oversized ovaries.

Question 21

What is the name of the test used to determine uterine tube patency?

Answer 21

Hysterosalpingogram

Question 22

What lifestyle advice is recommended in parents attempting to conceive?

Answer 22

Smoking cessation
BMI = 18.5-30
Reduce/Stop alcohol consumption
Moderate caffeine
Cessation of recreational drugs (including methadone)
Take folic acid supplementation

Question 23

What is responsible for 85% of ovulatory problems?

Answer 23

Polycystic ovarian syndrome

Question 24

What medication is first-line for ovulation induction?

Answer 24

Clomifene citrate

Can also give tamoxifen.

Question 25

At which stage in the ovulatory cycle should clomifene citrate be taken?

Answer 25

Take for first 5 days.

It is effective in 80% of cases.

Question 26

What medication is second-line in ovulation induction?

Answer 26

Gonadotrophin injection.

Monitor closely as can have side-effects.

Question 27

What is third (and last)-line in ovulation induction?

Answer 27

Laparoscopic ovarian diathermy

Question 28

If semen sample is abnormal, what tests should be performed?

Answer 28

LH/FSH
Testosterone
Prolactin
Genetic testing

Question 29

What genetic conditions are linked to azoospermia?

Answer 29

Klinefelter’s syndrome

Cystic fibrosis

Question 30

How is abnormal sperm circumvented to achieve conception?

Answer 30

IVF

Question 31

How is tubal disease treated?

Answer 31

No treatment.

Try IVF.

Question 32

How many IVF cycles are funded by the NHS?

Answer 32

3