Infertility

Question 1

what are the 3 types of ovulatory disorders?

Answer 1

hypothalamic-pituitary failure
hypothalamic-pituitary-ovarian dysfunction
ovarian failure

Question 2

what condition is caused by hypothalamic pituitary ovarian dysfunction?

Answer 2

polycystic ovarian syndrome

Question 3

what medication is given to stimulate ovulation in people with ovulatory disorders?

Answer 3

clomifene
gonadotrophin (FSH injection)

Question 4

what are the side effects of clomifene?

Answer 4

vasomotor

visual

Question 5

what is the role of clomifene and how does it work?

Answer 5

stimulates ovulation by blocking the oestrogen receptor in the anterior pituitary therefore increasing release of LH and FSH

Question 6

what are the main causes of infertility in females?

Answer 6

BMI (<19 or >25)
PCOS
congenital adrenal hyperplasia
androgen secreting tumour
acromegaly 
cushings
hydrosalpinx 
tumours
uterine septum
cervical abnormalities 
fibroids 
pelvic distortion

Question 7

what investigation i carried out to visualise the uterus, cervix and fallopian tubes?

Answer 7

hysterosalpingraphy

Question 8

what is hydrosalpinx?

Answer 8

tubal occlusion

Question 9

how is infertility by hydrosalpinx treated and can they get pregnancy after?

Answer 9

salpingectomy then gives IVF

Question 10

a female patient comes to the clinic with irregular periods and infertility as she has been trying for a baby for 2 years.
what blood test would you carry out?

Answer 10

FSH, LH, prolactin, testosterone and TSH levels at day 1-5 of her cycle

Question 11

a patient presents to the clinic with regular periods but cannot conceive after trying for 2 years.
what blood tests would you carry out?

Answer 11

progesterone levels at mid-luteal phase of cycle (day 21-25) to confirm ovulation

Question 12

a low BMI causes what type of ovulation disorder and how would you manage/treat?

Answer 12

hypothalamic-pituitary disorder
advise on weight gain - BMI >19
give pulsatile administration of GnRH or GnRH with LH activity to stimulate ovulation

Question 13

what are the main causes of infertility in males?

Answer 13

BMI 
epididymitis
varicocele
congenital bilateral absence of vas deferens / CF
primary hypogonadism i.e. kleinfelters

Question 14

how is sperm retrieved for IVF?

Answer 14

micro-epididymal sperm aspiration

testicular sperm extraction

Question 15

if its a male problem which is preventing the couple from getting pregnant, what methods of fertility can be offered to overcome the problem ?

Answer 15

IVF
intra-uterine insemination
surgery - sperm retrieval
donor insemination

Question 16

what questions would you ask in a fertility history of a male?

Answer 16

developmental: testicular decent , change in body hair
infections: STD’s (gonorrhoea, chlamydia), mumps
surgical: vasectomy, varicocele surgery
previous fertility

Question 17

what STD’s are associated with infertility in males and females? how?

Answer 17

gonorrhoea and chlamydia

they can cause pelvic inflammatory disease in females and epididymitis in males

Question 18

what is kleinfelters syndrome?

Answer 18

primary hypogonadism
karyotype with extra X chromosome i.e. XXY
cause of infertility in males

Question 19

why does CF cause infertility in males?

Answer 19

bilateral absence of vas deferens

Question 20

what are the causes of epididymitis and how does this cause infertility?

Answer 20

STD’s (gonorrhoea and chlamydia)
mumps
TB

causes seminiferous tubular necrosis and disrupts spermatogenesis

Question 21

what is varicocele and how can it lead to infertility?

Answer 21

abnormal dilatation and distortion of pampiriform plexus of the scrotum
the enlarged veins can damage the sperm and lower sperm count

Question 22

what investigations would you carry out if you suspected azoospermia?

Answer 22

history and examination
FSH, LH, testosterone, karyotype, PRL
CF screen

Question 23

what is the presentation of polycystic ovarian syndrome?

Answer 23

hirsutism 
infertility
irregular periods
acne
hypertension
overweight/obese
scalp hair loss

Question 24

what investigations would you carry out if you suspected PCOS?

Answer 24

serum total and free testosterone
serum TSH
serum prolactin 
serum dehydroepiandrogen sulphate (DHEAS)
pelvis USS

Question 25

what are the signs of PCOS on USS?

Answer 25

> 20 follicles which typically encircle the periphery of the ovaries, 2-9mm in diameter
ovarian volume > 10ml
endometrial lining > 5-7cm

Question 26

what criteria is used for diagnosing PCOS?

Answer 26

Rotterdam

Question 27

what is involved in the Rotterdam criteria for PCOS?

Answer 27

2 or more of the following:

hyperandrogegism / hyperandrogenaemia
ano/oligo ovulation
polycystic ovaries on USS

Question 28

what are the complications of PCOS?

Answer 28

infertility 
hypertension
CVD 
type 2 diabetes
psychosocial complications
endometrial hyperplasia or cancer
OSAS
NAFLD

Question 29

what is the first line treatment for PCOS if they want to get pregnant?

Answer 29

weight loss
+ metformin
clomifene (+dexamethasone)

Question 30

what are the 2nd and 3rd line treatments for someone with PCOS if they want to get pregnant?

Answer 30

2nd line: gonadotrophin

3rd line: laparoscopic ovarian drilling , IVF

Question 31

what treatment is given to reduce/reverse symptoms of hyperandrogegism in PCOS?

Answer 31

combined oral contraceptive pill