infertility

Question 1

what is the definition of infertility?

Answer 1

failure to achieve a clinical pregnancy after 12 months of more of regular unprotected sexual intercourse (in absence of known reason) in a couple who have never had a child

Question 2

what are the common causes of secondary infertility?

Answer 2

tubal disease
fibroids
endometriosis/adenomyosis
weight related
age related

Question 3

what are the gynaecological causes of anovulatory infertility?

Answer 3

Hypothalmic: anorexia/bulimia, excessive exercise,
Pituitary: hyperprolactinaemia, tumours, Sheehan syndrome
Ovarian: PCOS, premature ovarian failure

Question 4

what are some non-gynaecological causes of anovulatory infertility?

Answer 4

Systematic disorder: e.g. chronic renal failure.
Endocrine disorder: e.g. testosterone secreting tumours, congenital adrenal hyperplasia, thyroid
Drugs: e.g. depo-provera, explanon, OCP

Question 5

what are the clinical and endocrine feature of PCOS?

Answer 5

Clinical Features: obesity, hirsutism or acne, menstrual cycle abnormalities and infertility
Endocrine features: high free androgens, high LH, impaired glucose tolerance

Question 6

how do you diagnose PCOS?

Answer 6

score 2 out of three:
chronic anovulation
polycystic ovaries
hyperandrogenism (clinical or biochemical)

Question 7

what causes premature ovarian failure?

Answer 7

idiopathic, genetic, chemotherapy, radiotherapy, oophorectomy

Question 8

what are the clinical & endocrine features of premature ovarian failure?

Answer 8

clinical: hot flushes, night sweats, atrophic vaginitis, amenorrhoea, infertility
endocrine: high FSH, high LH, low oestradiol

Question 9

what are the infective causes of tubal disease?

Answer 9

Pelvic inflammatory disease (chlamydia, gonorrhoea, other: anaerobes, syphilis, TB)
transperitoneal spread: appendicitis, intra-abdominal abscess
following procedure: IUCD insertion, hysteroscopy, HSG

Question 10

what are non-infective causes of tubal disease?

Answer 10

endometriosis
surgical (sterilisation, ectopic pregnancies)
fibroids
polyps
congenital
salpingitis isthmica nodosa

Question 11

what is hydrosalpinx?

Answer 11

A hydrosalpinx is fluid blockage in your fallopian tubes that may make it difficult for you to become pregnant. Damage to your fallopian tubes, most often from an untreated infection, can cause a hydrosalpinx.

Question 12

what are the clinical features of hydrosalpinx due to pelvic inflammatory disease?

Answer 12

abdominal/pelvic pain febrile
vaginal discharge dyspareunia
cervical excitation menorrhagia
dysmenorrhoea
infertility
ectopic pregnancy

Question 13

what is the definition of endometriosis?

Answer 13

presence of endometrial glands outside uterine cavity

Question 14

what are the causes of endometriosis?

Answer 14

Retrograde menstruation (blood flowing back into pelvis instead of out of the vagina) is most likely cause, altered immune function, abnormal cellular adhesion molecules, genetic

Question 15

what are the clinical features of endometriosis?

Answer 15

dysmenorrhoea (classically before menstruation), dysparenuia, menorrhagia, painful defaecation, chronic pelvic pain, uterus may be fixed and retroverted, scan may show characteristic ‘chocolate’ cysts on ovary, infertility, asymptomatic

Question 16

what are some non-obstructive causes of male infertility?

Answer 16

47 XXY (klinefelter’s), chemotherapy, radiotherapy, undescended testes, idiopathic

Question 17

what are some obstructive causes of male infertility?

Answer 17

congenital absence (cystic fibrosis), infection, vasectomy

Question 18

what investigations do you do for female infertility?

Answer 18

endocervical swab for chlamydia
cervical smear if due
blood for rubella immunity
midluteal progesterone level , progesterone > 30nmol/l suggestive ovulation
Test of tubal patency: hysterosalpingiogram (HSG) /hycosy or laparoscopy
Others if indicated: e.g. hysteroscopy, ultrasound scan, endocrine profile and chromosomes

Question 19

what investigations do you do for male infertility?

Answer 19

examination & semen analysis- twice over 6 weeks
if abnormal can do hormone levels, endocrine profile, chromosome analysis, biopsy

Question 20

what vitamin supplements should be taken during pregnancy?

Answer 20

400micrograms of folic acid daily before pregnancy and in 1st trimester
10 micrograms vit D daily for pregnant & lactating people

Question 21

what treatment is done to induce ovulation in PCOS?

Answer 21

clomifene citrate
gonadotrophin therapy, daily injections
laparoscopic ovarian diathermy

Question 22

when is surgery used as a primary treatment for infertility?

Answer 22

-pelvic adhesions
-grade 1&2 endometriosis
-chocolate cysts in ovary
-tubal block