Infertility

Question 1

Give the definition of infertility?

Answer 1

Failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse (in a couple who have never had a child)

Question 2

What is primary infertility?

Answer 2

When the couple have never conceived

Question 3

What is secondary infertility?

Answer 3

The couple have previously conceived but the pregnancy was likely not successful - miscarriage or ectopic pregnancy

Question 4

Name 6 main things that can affect fertility?

Answer 4

Age - under 30 increases chance
Timing of intercourse - ovulation
Weight - low / healthy BMI
Smoking - avoidance
Caffeine intake - less than 2 cups of coffee daily
Recreational drugs - avoidance

Question 5

Give 5 common causes of secondary infertility?

Answer 5

• Age
• Weight
• Fibroids
• Tubal disease
• Endometriosis / adenomyosis

Question 6

What leads to 30-50% of male infertility?

Name other reasons for male infertility?

Answer 6

Idiopathic causation

Hypogonadism, undescended testes, urogenital infection, sexual factors, systemic disease

Question 7

Give pre-testicular reasons for male infertility?

Answer 7

Endocrine - hypogonadotropic hypogonadism, hypothyroidism

Coital disorders - erectile dysfunction, ejaculatory failure

Question 8

Give testicular reasons for male infertility?

Answer 8

Genetic - Klinefelter’s syndrome, Y chromosome deletion

Congenital - infective, antispermatogenic agents (heat, irradiation, drugs, chemo)

Vascular - testicular torsion, varicocele

Immunological - infection

Question 9

Give post-testicular reasons for male infertility?

Answer 9

Obstructive - congenital / infective epididymal reasons

Vasal - genetic (cystic fibrosis)
acquired - vasectomy, ejaculatory duct obstruction, idiopathic

Question 10

Give clinical features of undescended testes?

Answer 10

Low testicular volume, reduced secondary sexual characteristics and a present vas deferens

Question 11

Give endocrine features of undescended testes?

Answer 11

High LH
High FSH
Low testosterone

Question 12

Give clinical features of a vasectomy?

Answer 12

Normal testicular volume and secondary sexual characteristics
Vas deferens may be absent

Question 13

Give endocrine features of vasectomy?

Answer 13

Normal LH
Normal FSH
Normal Testosterone

Question 14

How should female infertility be investigated?

Answer 14

Endocervical swab for chlamydia
Bloods for rubella immunity
Cervical smear (if due)
Midluteal progesterone level
Tubal patency test

Question 15

When would a hysteroscopy be carried out in the case of female infertility?

Answer 15

In cases where there is high suspicion of or a known endometrial pathology

Question 16

If hirsutism is present - what tests should be carried out?

Answer 16

Testosterone and SHGB levels

Question 17

What should be done if there is amenorrhoea in infertile females?

Answer 17

An endocrine profile (anovulatory cycle)
Chromosome analysis

Question 18

What investigations should be done in a suspected infertile male?

Answer 18

History taking
Genital examination
Semen analysis

Question 19

How should a proper semen analysis be done?

Answer 19

Two samples should be taken for testing over 6 weeks apart

Question 20

If semen analysis is abnormal what further tests should be done?

Answer 20

LH and FSH
Testosterone
Prolactin
Thyroid function

Question 21

What should be done if there is abnormality on a male genital examination?

Answer 21

Scrotal ultrasound

Question 22

If a semen analysis is severely abnormal what can be done?

Answer 22

An endocrine profile
Chromosome analysis
Cystic fibrosis screen
Testicular biopsy