Infertility

Question 1

What is the definition of infertility? (long)

Answer 1

Failure of a couple to conceive after 12 months of regular intercourse without the use of contraception in women less than 35 years old or after 6 months in women greater than 35 years old

Question 2

What percentage of couples conceive within 12 months? 24 months?

Answer 2

85% within 12 months

95% within 24 months

Question 3

Why is there a decrease in fertility with agin?

Answer 3

Decline in quantity and quality of oocytes

Question 4

What are some external factors that can accelerate loss of oocytes?

Answer 4

Cigarette smoking
Radiation
Chemotherapy
Autoimmune disease

Question 5

What percentage of infertility can we blame men for? (Because blaming men for anything is awesome)

Answer 5

30%

Question 6

What are the most common causes of female infertility?

Answer 6

Ovulatory disorders (Most common!)
Endometriosis
Pelvic adhesions
Tubal blockage and other tubal abnormalities
Hyperprolactinemia

Question 7

On physical exam, what should you palpate in the neck that could cause female infertility?

Answer 7

Thyroid

Question 8

On physical exam, what should you check for in the breast that could be causing female infertility?

Answer 8

Galactorrhea (Spontaneous flow of milk from the breast not associated with pregnancy)

Question 9

What are some causes of male infertility?

Answer 9

Hypothalamic pituitary disease
Testicular disease (2nd most common)
Disorders of sperm transport
Idiopathic (Most common)

Question 10

Who should you check first when a couple is having trouble conceiving? The male or the female?

Answer 10

Male! It is easier.. he’s prob shooting blanks

Question 11

What labs should you check in a male when a couple is having issues conceiving?

Answer 11

Serum testosterone, LH, FSH and prolactin

Question 12

How long should a male be abstinent for before a semen analysis?

Answer 12

2-7 days

Question 13

How many semen samples should you take from a male when a couple is having fertility issues? How far apart?

Answer 13

At least 2 samples should be collected 1-2 weeks apart

This is bolded in Hoffmans ppt, I wager a pack of skittles it will be a test question

Question 14

As a PA in primary care or an OB/GYN office, should you be doing all of the investigation for an infertility evaluation?

Answer 14

No! You can do the initial basic fertility workup but always refer out to a fertility specialist

Question 15

When should you begin evaluation of infertility if a couple is having trouble conceiving and the woman is less than 35 without RF for infertility?

Answer 15

After 12 months of unprotected and “frequent” intercourse

Question 16

When should you begin evaluation of infertility if a couple is having trouble conceiving and the woman who is over 35?

Answer 16

After 6 months of unprotected and frequent intercourse

Question 17

In what type of patient population do you initiate evaluation upon presentation of infertility?

Answer 17

Women over 40
Women with oligomenorrhea/amenorrhea
Women with hx of chemo, radiation, etc.
Women with uterine/tubal disease
Women whose male partner has hx of testicular disease/dysfunction etc.

Question 18

What are some lifestyle modifications that can help with infertility?

Answer 18

SMOKING CESSATION!
Weight loss (can help induce ovulation)
Decrease excess caffeine and alcohol consumption (woman)
Appropriate timing and frequency of coitus (I hate that word)

Question 19

So theres this word in the powerpoint and it says “Laparoscopic ovarian diathermy” and guess what it means

Answer 19

Ovarian drilling

WHAT THE FUCK NO