Infertility

Question 1

What is the definition of infertility

Answer 1

Inability to conceive after 12 months of unprotected sex

Question 2

How are makes assessed for infertility

Answer 2

Semen analysis:

• Count (15M/mL)
• Motility
• Volume
• Total number

Question 3

How are females assessed for infertility

Answer 3

Menstrual cycle knowledge such as estrogen and progesterone levels. Also FSH and AMH. Variable
Timing of intercourse

Question 4

What are some causes of female infertility (6)

Answer 4

Anovulation
PCOS shown by infrequent/no periods. Overweight and increased androgens
Tubal disease such as ectopics and fibroid
Cervical problems
Endometriosis
Premature menopause
No uterus (MKRHS)

Question 5

What are some drugs and strategies used for each cause of female infertility?

Answer 5

Anovulation: Weight loss/gain; GnRH, FSH, letrazole (aromatase inhibitor)
PCOS: metformin, IVF, weight loss
Tubal disease: surgery/IVF
Cervical: IUI
Endometriosis: IVF, ablation, hormonal contraceptives
Premature menopause: Donor egg
No uterus: surrogacy

Question 6

What are the 6 steps of IVF

Answer 6

1) Ovarian stimulation with FSH, but controlled with GnRH antagonists. The trigger ovulation and luteal support
2) Egg retrieval
3) Sperm prep and fertilisation
4) Embryo culture
5) “ transfer
6) freezing

Question 7

What are some causes of male infertility and treatments

Answer 7

Oligospermia: ICSI, donor
OATS: ICSI
CAVD: ICSI
Azoospemria: Donor or sperm aspiration from the epididymis/testicle

Question 8

What are some recent innovations?

Answer 8

• Preimplantation genetic screening through trophectoderm biopsy
• Egg freezing
• Time lapse photography and single step media to analyse cell division of embryo

Question 9

Impact of age on fertility

Answer 9

One of leading causes
older eggs (40) have mitocondrial problems.
Age of first child increasing due to career, lack of knowledge, social situation.
Can do AMH tetsing

Question 10

ICSI

Answer 10

Select motile sperm, immobilize and aspirate tail first into needle

Suction pipette egg with PB at noon. Insert needle into egg and expel the sperm. Culture overnight

Question 11

Drugs used and effects

Answer 11

Letrozole: aromatase inhibitor
Metformin: lower sugar levels, for PCOS to stop diabetes
Clomiphene: upreglates gonadotrophin release by inhibiting E receptors, preventing the negative feedback