Infertility

Question 0

Main causes of infertility in women

Answer 0

• Tubal damage: from sexually transmitted diseases, complications of coil, any sepsis
• Primary ovarian failure
• Secondary ovarian failure – effects of age, premature menopause
• Polycystic ovarian syndrome
• Hypogonadotrophic hypogonadism – deficiency of follicle-stimulating hormone (FSH) and luteinising hormone (LH)

Question 1

Define infertility

Answer 1

Failure to conceive after 2 years of regular intercourse in the absence of known reproductive pathology

Question 2

Main causes of infertility in men

Answer 2

• Deficient spermatogenesis; congenital (e.g. Klinefelter’s syndrome) or acquired (e.g. chemotherapy)
• Previous vasectomy
• Antisperm antibodies
• Hypogonadotrophic hypogonadism
• Ejaculation disorders e.g. Retrograde ejaculation

Question 3

Questions to ask in a consultation with an infertile couple

Answer 3

–length of time trying to get pregnant
–frequency of sexual intercourse
–technique
–menstrual history
–previous abdominal or pelvic surgery
–previous genital pathology or treatment
–previous STD or pelvic inflammatory disease
–systemic or debilitating illnesses
–current medications including recreational drugs
–exercise, smoking and alcohol.

Question 5

Key predictors of successful conception

Answer 5

• The woman’s age
• Previous pregnancy history
• Duration of infertility

Question 6

Name 3 factors which have significant effects on the outcome of IVF (positive and negative)

Answer 6

Positive:
–Previous IVF pregnancy
–Previous live birth
–Younger age

Negative:
–Older age
–Obesity
–Longer duration of infertility
–Two or more IVF treatment cycles not resulting in a pregnancy
–Poor response to ovarian stimulation

Question 7

Risks of infertility treatment

Answer 7

Multiple pregnancies
Ovarian hyperstimulation syndrome
Increased risk of ovarian cancer
Increased risk of genetic abnormalities (ICSI)
Possible increased risk of minor birth defects (ICSI)

Question 8

What are the psychos-social impact of infertility

Answer 8

Issues of loss and grief (disappointment with failures)

Relationship pressures

Experiences of isolation (social stigma, embarrasment)

Feeling of guilt (denying partner a child, putting them through lengthy process)

Self blame
Anger

Psycho-sexual difficulties (pressure to have sex at a specific time)

Question 9

Factors which may affect coping in infertile patients

Answer 9

Personal: existing psychological problems (e.g. depression), view of parenting as a central life goal, use of avoidant coping strategies

Social: poor marital relationship, poor social network, reminders of infertility

Treatment: side effects of medication, treatment failure, decision making during treatment

Question 10

What are the three types of counselling in infertility

Answer 10

Implications counselling
Support counselling
Theraputic counselling

Counselling is a legal requirement of licensed centres. To be offered at all stages of treatment

Question 11

Implications counselling in infertility

Answer 11

Gives accurate, understandable factual information.

Aims to enable to individual concerned to reflect on the treatment on the individual, their family and children born as a result.

Must be available to everyone

Question 12

Support counselling in infertility

Answer 12

Emotional support that infertile couples need when experiencing the stress of a course of treatment can bring at any stage before, during or after treatment

Question 13

Theraputic counselling

Answer 13

Enables patients to explore their feelings and develop coping strategies for dealing with consequences of infertility treatment (short and long term)