Infertility

Question 1

What is infertility?

Answer 1

Unprotected sex for 3+/week for 12+ months and not getting pregnant

Question 2

How many couples suffer from infertility and what % couples conceive within 1 year of unprotected sex?

Answer 2

1/7 couples

80%

Question 3

What is primary and secondary infertility?

Answer 3

1 = never had children
2 = difficulty having subsequent babies

Question 4

What are some female causes of infertility?

Answer 4

-Low reserve = menopause and Sheehans

-Anovulation (PCOS, High T4, Eating disorders, chronic stress, High Prolactin)

-Structural (endometriosis, fibroids + turners, ashermans)

-Tubular (PID)

Question 5

What are some male causes of infertility?

Answer 5

Poor sperm quality
low testosterone
High prolactin
(+ haemochromatosis, Kallmans, Testicular Ca, Noonans, klinefelter syndrome)

Question 6

What investigations are done in Males for infertility?

Answer 6

Sperm and semen analysis
Blood hormone levels:
-testosterine
-prolactin
-FSH,LH

Question 7

For the sperm and semen analysis, what should these be:
-pH
-Volume
-Conc
-Motility
-Normal morphology

Answer 7

pH = >7.2
Vol = 1.5 mL (1.4-1.7)
Conc = 1.6 million/mL (1.2-1.6)
Motility = >42%
Normal morphology = >4%

Question 8

What would be done if the male infertility test is abnormal?

Answer 8

Repeat in 3 months (take within 3-5 days abstinence)

Question 9

What are the investigations done for infertility in females?

Answer 9

Bloods: Oestrogen, progesterone, LH:FSH, Prolactin, shBG
Mid luteal (day 21) progesterone = High
AMH any day = High
FSH day 2-5 = Low

TV USS

NAAT swab

+ tubal patency testing :

-HSG (Hysterosalpingogram) + contrast (better, less invasive, no anaesthetic)
-Laparoscopy + contrast (under GA - Less common)

Question 10

Tx for infertility in young people?

Answer 10

Try for further 6 months then come back
>35y = earlier referral

Question 11

What is a medical Tx for infertility?

Answer 11

Clomifene

Question 12

Clomifene
Mechanism?
SE?
Success rate?

Answer 12

Stimulates ovulation, oestrogen modulator –> inhibits HPG -ve feedback on GnRH, High GnRH, High FSH + LH, High ovulation

Flushing, Mittelschmirtz (ovulation pain), blurred vision

50% success rate

Question 13

What can clomifene also help with?

Answer 13

spermatogenesis

Question 14

What is Last line for infertility Tx?

Answer 14

IVF
IUI (Intrauterine insemination)
ICSI (Intracytoplasmic sperm injection)
Not conceived for 2+ years

Question 15

What is the mechanism of IVF?

Answer 15

In Vitro Fertilisation
Culture egg + sperm in vitro 3-5 days them implant into uterus (often concomitant bhCG given) - monitor with serial serum bhCG

Question 16

IVF has a higher success in who?
how many cycles can be done and what age?

Answer 16

higher success in younger Px

Can have 3 or less cycles on NHS under 40y

Question 17

What are 3 main complications of IVF?

Answer 17

Ectopic preg
Twin preg
Ovarian hyperstimulation syndrome (OHSS)

Question 18

What is the mechanism behind ovarian hyper stimulation syndrome?
Tx?

Answer 18

High bhCG = High vascular endothelial GF = Ascites + oliguria + ovaries >10cm

Tx = ABCDE, IV Colloid + monitor urine output + LMWH