Infertility

Question 1

Fecundability

Answer 1

likelihood of getting pregnant in 1 cycle

Question 2

What percent of infertility is from men vs. women?

Answer 2

men - 20%

female -65%

Question 3

What are some ways of improving fertility?

Answer 3

• don’t exercise too much
• don’t lose too much weight
• Don’t smoke
• Don’t drink
• Don’t use vaginal lubricants
• Avoid scrotal hyperthermia

Question 4

What is the most common defect in male fertility?

Answer 4

testicular defects in spermatogenesis

Question 5

What is the most common reason for female infertility?

Answer 5

ovulatory disorders (25%)

Question 6

What labs need to be done to assess fertility?

Answer 6

• hCG
• TSH
• Total testosterone
• DHEA-S
• FSH
• LH
• estradiol

Question 7

What labs need to be drawn if the women is infertile and anovulatory?

Answer 7

Day 3: FSH and estradiol

Question 8

In an anovulatory patient what is the cause if you have high FSH and low estradiol?

Answer 8

Ovarian failure

Question 9

What is the most important initial test to run for male infertility?

Answer 9

Semen analysis

Question 10

Which test for the female partner can be diagnostic in assessing patency of fallopian tubes in infertility but also therapytic in endometriosis?

Answer 10

-Hysteroscopy with dye

Question 11

What are the 3 most important values to look for on the semen analysis?

Answer 11

1. Count (>20 million)
2. Motility (>50%)
3. Morphology

Question 12

When do abnormal semen results need to be repeated?

Answer 12

> 4 weeks

Question 13

Which labs are important to consider in male infertility?

Answer 13

Testosterone
FSH
LH
Prolactin

Question 14

Low testosterone, High FSH, High LH?

Answer 14

primary hypogonadism

Question 15

What could be the cause if a patient has low LH, low sperm count but normal sperm count?

Answer 15

exogenous steroids

Question 16

If the couple is <35 years, what should you recommend?

Answer 16

timed intercourse

Question 17

What is the treatment of choice if the women is <36 with oligomenorrhea/amenorrhea with normal FSH, including PCOS?

Answer 17

Clomiphene citrate

ADE: hot flushes, emotional lability, depression, bloating, vision changes

Question 18

What is the preferred medication for female infertility if the women has history of estrogen dependent tumor?

Answer 18

Letrozole

Question 19

For a couple with 12 months of infertility, how is ovulation evaluated and when?

Answer 19

Progesterone level on day 21

<5ng –> need to find cause
(>5ng –> indicates ovulation

Question 20

Why is Clomiphene citrate limited to only 6 cycles?

Answer 20

increased risk of ovarian cancer

Question 21

What is the main adverse events associated with Ovulation induction with gonadotropins?

Answer 21

1. Multiple gestations

2. Increased risk of ectopic pregnancy

Question 22

If the cervix is to blame for infertility, what are 2 treatment options?

Answer 22

1. Intrauterine insemination (IUI)

2. Doxycycline

Question 23

If the male partner has poor quality semen (mild to moderate) what is a treatment to consider?

Answer 23

Intrauterine insemination (IUI)

$350 an attempt

Question 24

If the male partner has severe infertility what is the most commonly used treatment?

Answer 24

Intracytoplasmic sperm injection (ICSI)
-sperm injected into oocyte

$1500-3000

Question 25

Once an embryo is implanted with in vitro fertilization, what needs to be taken and how long?

Answer 25

Progesterone needs to be taken for 10 weeks gestation

$10,000-$15,000