Infertility

Question 1

List some causes of Infertility
(Think broad causes/categories)

Answer 1

• Ovulation factors (25%)
• Male factors (30%)
• Tubal disease (20%)
• Unexplained infertility (25%)
• Endometriosis
• Uterine factors
• Other

Question 2

List 4 causes of Anovulation

Answer 2

Polycystic ovarian syndrome
Weight-related (BMI >30 or BMI <18 can both result in anovulation)
Ovarian failure (eg Premature ovarian failure or Secondary to Radio/Chemo)
Hyperprolactinaemia

Question 3

List 3 causes of Tubual disease resulting in Infertility

Answer 3

Pelvic inflammatory disease,
Pelvic surgery (adhesions),
Endometriosis,

Consider complications from previous ectopic pregnancies too

Question 4

What baseline investigations would you perform for Females struggling to conceive?

Answer 4

Follicular phase = LH + FSH
Luteal phase = Progesterone

Rubella status

Cervical smear (if not done recently)

Chlamydia testing (if 2x negative tests can perform Hysterosalpingography)

Additional ix = Pelvic USS; Hysteroscopy; Prolactin/TFT’s; Testosterone/SHBG

Question 5

What investigations would you perform for Males struggling to conceive?

Answer 5

Semen analysis x2

Additional Ix = LH, FSH, Testosterone, Ultrasound of seminal vesicles and prostate

Question 6

Give 2 treatments for Anovulation

Answer 6

Clomiphene citrate
Gonadotrophins / Pulsatile GnRH

Dopamine agonists (hyperprolactinaemia)

Weight loss / Weight gain if necessary

Primary ovary insufficiency = egg donation

Question 7

What is the definition for infertility?

Answer 7

Inability to conceive after 12 months of regular unprotected sexual intercourse

Can be primary (no previous pregnancies) or secondary (previous pregnancies)