Infertility

Question 1

How common is Infertility

Answer 1

1 in 7 couples report infertility problems

Question 2

When would one begin investigating claims of infertility

Answer 2

• After 1 year of a couple trying to get pregnant with no success(<35yrs, 6months if 35-45yrs)
• Period irregularity
• PMH
• Testicular problems
• HIV/Hep B
• Anxiety

Question 3

Female infertility Hx

Answer 3

• Duration of infertility
• Previous contraception
• Fertility in previous relationships
• Previous pregnancies + complications
• Menstrual Hx
• Medical + surgical Hx
• Sexual Hx
• Previous investigations
• Psych assessment

Question 4

Female infertility Hx

Answer 4

• Weight and height
• BMI (kg/m2)
• Fat and hair distribution
• Galactorrhoea (milky secretion from nipple, not normal milk)
• Abdo exam
• Pelvic exam`

Question 5

What is Acanthosis Nigricans and what is it a sign of with relevance to infertility

Answer 5

• Dark, thickened, velvety skin in body folds and creases
• Typically in armpits, groin and back of the neck
• Usually appears slowly
• Polycystic Ovary Syndrome (PCOS)

Question 6

What causes Polycystic Ovary Syndrome (POCS)

Answer 6

Caused by elevated androgens (male hormones) in women

Question 7

Signs and Symptoms of Polycystic Ovary Syndrome (PCOS)

Answer 7

• Acanthosis Nigricans
• Difficulty getting pregnant
• Irregular/no/heavy periods
• Hirsutism (excess body and facial hair)
• Pelvic pain
• Acne

Question 8

Treatment for PCOS

Answer 8

• Oral contraceptives
• Metformin
• When associated with obesity weight loss is recommended

Question 9

Cause of Galactorrhoea

Answer 9

A prolactinoma

Question 10

Main points of pelvic exam

Answer 10

• Masses
• Pelvic distortion
• Fixed retroversion
• Tenderness

Question 11

What are fibroids

Answer 11

• Non-cancerous growths that develop in or around the uterus
• Made up of muscle and fibrous tissue and vary in size
• Many women are asymptomatic

Question 12

What can fibroids cause

Answer 12

• Pressure symptoms
• Period problems
• Infertility

Question 13

Male infertility Hx

Answer 13

• Previous fertility
• Medical and surgical Hx
• Occupational Hx
• Sexual Hx
• Previous investigations and treatments

Question 14

Male infertility exam

Answer 14

-BMI
-Fat and hair distribution (hypoandrogenism)
-Ado and inguinal exam
-Genital exam
Testes
Epididymis
Vas deferens
Varicocele
Penis

Question 15

3 causes of epididymitis

Answer 15

• Chlamydia Trachomatis
• Gonorrhoea
• NSTD

Question 16

What is Klinefelter’s Syndrome and what can it cause

Answer 16

• 47 XXY
• Causes small testicles and reduced libido
• Infertility
• Osteoporosis

Question 17

What investigations would you carry out for female infertility

Answer 17

-Rubella immunity
-Chlamydia
-TSH
-Mid luteal progesterone, 7 days prior to expected period (if periods are regular)
-If periods are irregular day 1-5;
FSH
LH
PRL
TSH
Testosterone
-Pelvic ultrasound
-Tubal patency test

Question 18

What investigations would you carry out for male infertility

Answer 18

Semen analysis

Question 19

1 feature of a Hx + exam that would suggest Polycystic Ovary Syndrome (PCOS)

Answer 19

• Hirsutism

- Anovulation (infrequent periods)

Question 20

How to induce ovulation

Answer 20

• Clomifene
• Gonadotrophins
• Gonadotropin-releasing hormone (GnRH)

Question 21

What is Azoospermia

Answer 21

When semen contains no sperm

Question 22

What do PR, CF Screen, FSH, LH stand for

Answer 22

• PRL = Prolactin
• CF Screen = Cystic fibrosis screen
• FSH = Follicle-stimulating hormone
• LH = Luteinizing hormone

Question 23

Treatment for Azoospermia

Answer 23

-Surgical retrieval of sperm
Micro-epididymal sperm aspiration
Testicular sperm extraction

Question 24

Number of births due to IVF

Answer 24

12,000 (2% of total UK births)