infertility

Question 1

what is infertility?

Answer 1

inability to conceive >12 months regular intercourse without contraception

Question 2

how long regular menstrual cycle
-how long follicular
-when ovulation
-how long luteal

Answer 2

regular cycle 28-35 days
-follicular is variable
-ovulation usually day 14 (14 days before end of cycle)
-luteal is always 14

Question 3

what is oligomenorrhoea and amenorrhoea

Answer 3

oligomenorrhoea: cycles >35 days
amenorrhoea: absent menstrual cycles

Question 4

what hormone triggers ovulation?

Answer 4

LH surge triggers ovulation

Question 5

what hormone peaks following ovulation?

Answer 5

Progesterone

Question 6

what hormone does an at home ovulation predictor kit detect?

Answer 6

LH

Question 7

what hormone is measured in medical setting when predicting ovulation and why?

Answer 7

For regular cycles:

Midluteal (day 21) serum progesterone !!!

-if ovulation has occured then corpus luteum will be producing progesterone which should peak mid luteal phase (before corpus luteum begins to break down)

For irregular cycles: (anovulatory)
-further hormone evaluation

Question 8

investigations in GP for amenorrhoea?

Answer 8

-Follicular phase bloods: LH, FSH and E2
-Testosterone, SHBG, FAI
-Prolactin

Question 9

azoospermia- what?

Answer 9

no sperm in ejaculate

Question 10

asthenozoospermia- what?

Answer 10

% progressive motile sperm below reference limit

(sperm with low motility)

Question 11

oligozoospermia- what?

Answer 11

total number/ concentration of sperm below reference limit

(low sperm count)

Question 12

teratozoospermia- what?

Answer 12

% morpholoically normal sperm below reference limit

(lots of abnormal looking sperm)

Question 13

what is done for women in infertility consultation?

Answer 13

-History
-Examination
-TVUS (looking at uterus and ovaries)
-Investigations

-Establish length of relationship and length trying to get pregnant

Question 14

what is done for men in infertility consultation?

Answer 14

-history
-examination
-Diagnostic semen analysis
-Investigations

-Establish length of relationship and length trying to get pregnant

Question 15

what investigations done to test tubal patency?

Answer 15

Hysterosalpingogram (HSG)
- if no known risk fators tubal/ pelvic pathology
(this is like scan of uterus)

DIAGNOSTIC= LAPARASCOPIC + HYDROTUBATION (HTB)

if suspected or known endometrial pathology= hysteroscopy

Question 16

what investigation should be done if there is suspected or known endometrial patholgoy?

Answer 16

hysteroscopy

Question 17

what lifestyle advice is given for someone trying to conceive?

Answer 17

-stop smoking
-BMI 18.5 to 30
-Reduce/ stop alcohol consumption
-moderate caffeine
-Stop recreaion drugs/ methadone
-Folic acid

Question 18

what is the commonest reason for ovulation problems

Answer 18

PCOS

Question 19

criteria for PCOS?

Answer 19

ROTTERDAM CRITERIA
2 of:
-oligo/amenorrhoea
-clinical or biochemical signs of excess androgens
-Polycystic ovaries on US (12/more 2-9 mm follicles, >10mls fluid, unilateral/ bilateral)

Question 20

management decreased fertility in PCOS?

Answer 20

1st line= Clomifene citrate +/- metformin
alternatively letrozole (tamoxifen)

Others:
-Gonadotrophin injections
-Laparascopy ovarian drilling

Question 21

treatments offered to men with abnormal semen parameters?

Answer 21

-Intrauterine insemination (IUI)
-In vitro fertilisation (IVF)
-Intracytoplasmic sperm injection (ICSI)

Question 22

treatment for a blocked fallopian tube?

Answer 22

Generally no treatment:
-IVF (but hydrosaplinx decreases IVF success by 50%)

Question 23

what is the ART eligibility for assisted conception?

Answer 23

-Stable relationship of 2 years
-Female age <40
-Female BMI 18.5 to 30
-Non smokers
-No biological children
-No illegal/ abusive substances (including methadone)
-Neither partner to have been steralised
-Duration unexplained fertility 2 years
-Up to 3 cycles of treatment