Infertility

Question 1

how many couple present with infertility

Answer 1

1 in 6 couples

Question 2

why is infertility increasing in incidence (3)

Answer 2

increasing paternal age
chlamydia
more same sex couples

Question 3

infertility definition

Answer 3

failure to achieve pregnancy after 12 months of regular unprotected sex in a couple who have never had a child

Question 4

what is the difference between primary and secondary infertility

Answer 4

primary infertility - couple never conceived

secondary infertility - couple who have conceived but pregnancy unsuccessful (miscarriage or ectopic)

Question 5

hypothalamic causes of hypogonadotropic hypogonadism = causing infertility (4)

Answer 5

anorexia/excessive exercise
kallmans syndrome
stress
drugs

Question 6

pituitary causes of hypogonadotropic hypogonadism = causing infertility (3)

Answer 6

hyperprolactinaemia
sheehans syndrome (hypopituitarism cause by hypovolaemic shock after PPH)
pituitary tumours

Question 7

ovarian causes of infertility (3)

Answer 7

PCOS
POF
endometriosis

Question 8

tubal causes of infertility (3)

Answer 8

chlamydia - causes PID
hydrosalpinx - fluid dilatation of fallopian tubes
endometriosis - narrows tube

Question 9

4 potential areas of problem causing infertility in women

Answer 9

hypothalamus
pituitary
ovaries
fallopian tubes

Question 10

apart from drugs and idiopathic causes, where can the problem be in men with infertility (3)

Answer 10

pre testicular
testicular
post testicular (obstructive)

Question 11

causes of pretesticular infertility (4)

Answer 11

pituitary problem = hyperprolactinaemia
kallmans syndrome
anorexia
steroid abuse

Question 12

testicular causes of infertility (4)

Answer 12

kleinfelters syndrome (XXY) = testicular failure
varicocele
cryptorchidism (undescended testes)
chemo/radio

Question 13

post testicular (obstructive) causes of infertility

Answer 13

ejaculatory gland obstruction
erectile dysfunction
vasectomy
absence of vas deferens (cystic fibrosis)

Question 14

investigations for female infertility

Answer 14

chlamydia screen - endocervical swab
baseline hormone profile (menstruation cycles)
pelvic exam/US (for PCOS/abnormal growths)
tubal patency tests - hysterosalphingogram (HSG)

Question 15

what is a hysteroslaphingogram (HSG)

Answer 15

contrast inserted into uterine cavity + xray takento look at patency of fallopian tube s(fluid should leak out into peritoneal cavity

Question 16

investigations for male infertility

Answer 16

chlamydia screen - first pass urine sample 
testes size (compare to beads)
semen analysis (sperm count)

Question 17

normal size of testes

Answer 17

12-25ml

Question 18

what is azoospermia

Answer 18

no sperm

Question 19

what are you looking for in semen analysis

Answer 19

semen volume 
sperm concentration 
sperm morphology 
WBC 
sperm motility

Question 20

how long must a male abstain for before a semen analysis

Answer 20

abstain from sex for 3 days

Question 21

if semen analysis is abnormal what do you do

Answer 21

endocrine profile - LH, FHS, testosterone, prolactin, TFTs

Question 22

what is oligoasthenospermia

Answer 22

low count and low mobility sperm

Question 23

what is teratoosthenospermia

Answer 23

low count and abnormal form of sperm

Question 24

first line treatment for infertility

how many people is this effective for

Answer 24

lifestyle advice!!

increase sexual intercourse - for 6 days before ovulation 
lose/gain weight (BMI 18.5-30)
stop smoking 
reduce alcohol 
reduce coffee 

effective for half of infertile people!

Question 25

second line treatment (if lifestyle modification doesn't work) for male infertility (3)

Answer 25

donor sperm intrauterine sperm insemination intracytoplasmic sperm injection

Question 26

what can you give a male with infertility caused by hyperprolactinaemia

Answer 26

cabergoline

Question 27

when would you used intrauterine sperm insemination/intracytoplasmic sperm injection

Answer 27

failed IVF

Question 28

difference between intrauterine sperm insemination and intracytoplasmic sperm injection

Answer 28

IUSI - sperm inserted into uterus | ICSI - sperm injected straight into egg, then into uterus?

Question 29

usually males can ejaculate their own sperm used for IUSI/ICSI, what are the alternatives if they cant (2)

Answer 29

surgical sperm aspiration | donor sperm

Question 30

second line treatment (if lifestyle modification doesn't work) for female infertility (4)

Answer 30

IVF surrogacy - another female carries baby egg donation HRT

Question 31

which hormone is used to assess ovarian reserve prior to IVF

Answer 31

anti Mullerian hormone (AMH)

Question 32

IVF process (3)

Answer 32

semen and egg both collected egg fertilization in lab embryo implanted in uterus

Question 33

when can you use HRT for infertility

Answer 33

if hypothalamic/pituitary problem (not if ovarian/tubal problem)

Question 34

which hormones can be give in HRT for infertility

Answer 34

GnRH LH and FSH dependent on if problem is hypothalamic/pituitary

Question 35

complications of HRT

Answer 35

ovarian hyperstimulation syndrome (OHSS) = swollen - ascites

Question 36

what is a heterotopic pregnancy | when is there an increased risk for this

Answer 36

2 pregnancies - 1 in uterus 1 ectopic | IVF risk factor