Infertility

Question 1

What are the causes of infertility?

Answer 1

Ovulatory pathology
Tubal pathology e.g. STis/ endometriosis
Male infertility- oligozoospermia, asthenozoospermia, teratozoospermia

Question 2

What is meant by ovulatory pathology?

Answer 2

Hypogonadotropic hypogonadism- kallman syndrome/ anorexia
Hypothalamic-pituitary- ovarian disorders e.g. PCOS
Ovarian failure
Chronic disease

Question 3

When should we investigate?

Answer 3

To be done after 1 year regular UPSI
Woman >36 and for 6 months
History of oligomenorrhoea or amenorrhoea
History of PID/STI

Question 4

What investigation should be done for women?

Answer 4

Mid luteal phase progesterone
- 28 day cycle take on day 21
<16- repeat and refer to specialist
16-30 repeat
>30 indicates ovulation

Consider FSH/LH
- low in hypogonadotropic hypogonadism e.g. anorexia
- High in ovarian failure

Prolactin
TFTs
STI screen

Tubal patency test
- no history of comorbidities hysterosalpingography
- if history then diagnostic laparoscopy and dye

Question 5

What is the management?

Answer 5

Medical-
Clomifene
Surgery if abnormalities
IVF

Question 6

What is Ovarian Hyperstimulation Syndrome?

Answer 6

Complication of fertility treatment
Multiple of lutienized cysts within the ovaries causing increased levels of oestrogen/progesterone and VEGF

Question 7

What are symptoms of OHSS?

Answer 7

Abdo pain
Abdominal bloating
Nausea and vomiting
US evidence ascites

Severe
- oliguria
-oedema
- VTE
- hydrothorax
- haematocrit >45%
- ARDS