Infertility

Question 1

Over two years what are the rates of pregnancy if certain criteria are met (what are those criteria?)

Answer 1

Woman <40
No contraception
Regular sex (every 2-3 days)

80% conceive in a year, 90% in two years

Question 2

Difference in subfertility and infertility?

Answer 2

Infertility - cannot conceive at all

Subfertility: > 12 months trying to conceive with reg. sex and no contraception.

Question 3

Three basic principles in infertility investigations, and their respective investigations?

Answer 3

Is there an egg?
- Mid luteal phase progesterone (day 21 in 28 day cycle)

Is there a sperm?
- Semen analysis

Can they meet?
- Tubal potency test

Question 4

How many sperm per ml is normal?

Answer 4

15 million

Question 5

Disorders of ovulation in females? (4)

Answer 5

Group I:

HPA failure (hypogonadotrophic hypogonadism): Hypothalamus does not produce GnRH, then less FSH is produced and less oestrogen is produced (so LH can’t start ovulation).

• Low FSH and Oestrogen

Group II:

Hypothalamic-pituitary-ovarian failure, as a result of PCOS.
- Normal levels of FSH and Oestrogen

Group III:

Hypergonadotrophic hypogonadism, so there is okay GnRH, and therefore FSH, but low/no follicles and therefore no oestrogen and no LH.
- High FSH, Low Oestrogen

Hyperprolactinaemia:
- High prolactin causing negative feedback to the hypothalamus (resulting in decreased release of GnRH and subsequently FSH & LH)

Question 6

Male factors affecting fertility? (4)

Answer 6

Hormones

Spermatogenesis

Erection

Ejaculation

Mumps

Question 7

Female factors affecting fertility? (4)

Answer 7

Hormones

Oogenesis

implantation

Pregnancy itself

Question 8

Causes of hyperprolactinaemia?

Answer 8

1. Pituitary tumour - releasing prolactin
2. Medications/tumours - blocking PIF (prolactin inhibitory factory) and causing a rise in prolactin
3. Hypothyroidism - stimulating prolactin

Question 9

Ovarian dysfunction causing infertility

Answer 9

1. PCOS (also ovarian group II)
2. Premature ovarian failure
   - no follicles, can be due to surgery, chemo, autoimmune e.t.c.
3. Luteal Phase disorders:
   - Abnormality in the function of the corpus luteum
   - Insufficient progesterone production

Question 10

Pelvic, tubule and uterine disorders affecting fertility?

Answer 10

Ectopics

Endometriosis

PID, Endometriosis , STIs

Abnormal cervical mucus

Uterine: Fibroids, intrauterine adhesions,

Question 11

What does the mid-luteal phase progesterone test for? When would you do it?

Answer 11

Tests for ovulation

Taken half-way through the luteal phase (7 days before period)

Question 12

How would you test for tubal patency (as a cause of female infertility)?

Answer 12

HSG (hysterosalpingogram) - if no comorbidities.

If comorbidities then laparoscopy and dye test

Question 13

General lifestyle/health caused for male infertility?

Answer 13

Obesity

Alcohol and drugs

Mumps

Question 14

Treatment for infertility?

Answer 14

Ovulation induction
- Clomiphene

Intrauterine insemination

Surgical

IVF
- Intracytoplasmic sperm injection