Infertility

Question 1

What is infertility?

Answer 1

Infertility is the inability to achieve pregnancy despite regular unprotected sexual intercourse for a period of 1 year

Question 2

___ % of married couples having regular sex should conceive within 6 months, ____ within 12 months and ____ within 18-24 months.

Answer 2

60%
90%
95%

Question 3

About the epidemiology of infertilty in Africa. Answer True or False.

i. There is a recognised infertility belt extending from West Africa to East Africa.
ii. In Southern Africa, Lesotho has the highest proportion of subfertility, with a prevalence of 37%
iii. The infertility belt corresponds to the AIDS belt
iv. Infertility has no correlation with STIs
v. Areas of infertility in Africa include Cameroon, Chad, CAF, Gabon etc.

Answer 3

i. True
ii. True
iii. True
iv. False
v. True

Question 3

i. Infertility rate ranges from 8.6-21.5% in developing countries, with Eastern Africa having the lowest and Southern Africa the highest.
ii. 85% of infertility diagnosis in African women is associated with prior STI

Answer 3

i. True
ii. True

Question 4

What are the most implicated STIs in infertility?

Answer 4

Gonorrhea, Chlamydia and HPV

Question 5

The major preventable causes of infertility in developing countries are:

Answer 5

i. STIs
ii. Post-partum infection
iii. Post-abortion infection

Question 6

The cause of infertility in men is _________.

Answer 6

sperm defects

Question 7

Mention 10 causes of infertility in women.

Answer 7

1. Pelvic inflammatory disease (PID)
2. Endometriosis
3. Benign uterine fibroids
4. Ovarian cyst
5. Polycystic ovarian syndrome

PEBOB

6. Drugs
7. Physical damage from IUDs
8. Physical damage from pelvic surgeries
9. Hyperthyroidism and hypothyroidism
10. Irritable bowel syndrome (IBS)
11. Epilepsy

Question 8

The major cause of infertility worldwide is _________

Answer 8

Pelvic Inflammatory disease.

Question 9

What are the roles of the pharmacist in infertility.

Answer 9

1. Prevention
2. Infertility work-up
3. Counselling
4. Management
5. Referrals
6. Information and awareness

Question 10

Mention 7 things a pharmacist is expected to do in the prevention of infertility.

Answer 10

A pharmacist should:
1. Be updated on the prevention, diagnosis and treatment of STIs and PID
2. Know that choice of contraceptives influences risk of PID
3. Engage in public education on the consequences of untreated STIs
4. Assist young people in identifying STI risk factors
5. Ensure access to early and confidential diagnosis and treatment if STIs
6. Encourage safe sex practices
7. Inform patients on the risk of infertility with abortion.

Question 11

In the use of IUD for contraception, a pharmacist should:

Answer 11

i. Never insert an IUD in a patient with untreated STIs
ii. Avoid recommending IUDs to patients at high risk of STIs or PID
iii. Screen patients with UIDs for STIs
iv. Be conservative about recommending IUDs to women who have never had kids but intend to
v. Assume that vaginal discharge with IUD is a sign of infection until otherwise proven
vi. Prescribe prophylactic antibiotics to patients in areas with high STI incidence.

Question 12

The pharmacist serving in the capacity of a fertility counselor should begin an infertility evaluation as soon as is reasonable, if the following conditions apply:

Answer 12

i. The woman is in her late 30s
ii. The woman has irregular menses
iii. The woman has severe dysmenorrhea or dyspareunia
iv. Woman has used IUDs in the past
v. Medical history includes mumps in the man or PID, miscarriages and ectopic pregnancy in the woman or pelvic surgery or serious medical problem in both
vi. The couple lives in an area with high incidence of STIs

Question 13

What are the basic initial work up (evaluation) services that can be provided by the Pharmacist?

Answer 13

i. Educating the patients
ii. Gathering pertinent historical information
iii. Providing a thorough physical examination

Female - Visually evaluate the hair distribution and body and breast development for signs of endocrinopathies. Perform a pelvic exam to detect any pathologies.
Male – Visually inspect sexual characteristics to identify endocrinopathies

iv. Providing a resource for reassurance, counseling, and emotional stability, including referrals as needed

v. Making a plan and initiating treatment based on information gathered, and counseling couples about their options for further evaluation and treatment.

vi. Reassessing progress at predetermined intervals

Question 14

What is the procedure for collecting semen for evaluation?

Answer 14

• Abstain from intercourse (no ejaculation) for at least 3 and no more than 5 days.
• Do not drink alcohol or take a hot shower or bath just before producing semen
• Masturbate.
• Ejaculate into a small, sterile, dry, wide-mouth jar
• Take the semen specimen to the laboratory within an hour of collection,
  Keeping the semen specimen close to body temperature

Question 15

What is the normal sperm count?

Answer 15

20 million sperm cells per ml.

Question 16

What are the WHO Criteria for normal semen sample?

Answer 16

1. Sperm concentration >20 x 10^6/ml
2. Motility >40%
3. Morphology >50% normal cells
4. Viability > 60%
5. No agglutination
6. Seminal fluid
7. Normal appearance
8. Normal viscosity
9. < 10^6 White blood cells per ml

Question 17

What is comprehensive infertility treatment?

Answer 17

Comprehensive infertility treatment is an approach that seeks to maximize the chance of pregnancy by optimizing all conditions for conception

Question 18

What is the approach for male infertility?

Answer 18

Insemination from donor sperm

Question 19

What are the approaches for female infertility?

Answer 19

1. insemination or uterine instillation of specially prepared sperm in the case of cervical mucus problems impairing conception
2. Cerclage, bed rest or both in the case of cervical incompetence interfering with continuing pregnancy
3. Use of drugs to induce ovulation e.g. clomiphene citrate, (which suppresses estrogen’s suppressive effect on ovulation). and bromocriptine (suppress prolactin in women whose ovulation is suppressed by hyperprolactinemia)
4. Use of high technology fertility medicine with ova donated from another woman to deal with premature menopause or damage to ovaries
5. Surgical procedures to correct uterine or tubal abnormalities

Question 20

Mention 2 high technology fertility techniques.

Answer 20

1. Gamete intra-fallopian tube transfer (GIFT): This involves placing a mixture of ova and sperm into the fallopian tube. It is used primarily for unexplained infertility and where the fallopian tubes appear normal
2. In vitro fertilization: This involves placing mature ova with specially prepared sperm in a laboratory tissue culture medium and incubating them to allow fertilization. Fertilized ova that have successfully attained a certain maturity are placed in the uterus via a trans-cervical catheter