Infertility

Question 1

How is infertility defined?

Answer 1

Inability of a couple to conceive after 12 months of regular intercourse without use of contraception

Question 2

Causes of infertility in women

Answer 2

PCOS
Over/underactive thyroid
Premature ovarian failure
Scarring from surgery
Fibroids
Cervical mucus problems
Endometriosis
Pelvic inflammatory disease
Sterilisation

Question 3

Causes of infertility in men

Answer 3

A lack of sperm
Sperm that aren't moving properly
Abnormal sperm
Testicular problems (eg cancer, infection etc)
Sterilisation
Ejaculation disorders
Hypogonadism

Question 4

Investigations at fertility clinic

Answer 4

Pelvic Ultrasound
Physical examination
Testing for ovulation 
Tubal patency test
Semen analysis repeat if required

Question 5

What should blood tests from women who are undergoing investigations for infertility be measuring? (regular cycle)

Answer 5

Serum progesterone in the mid luteal phase of their cycle to confirm ovulation

Question 6

When is the mid-luteal phase of the menstrual cycle?

Answer 6

Day 21-28

Question 7

What should be measured by blood test in women with irregular menstrual cycles?

Answer 7

Serum gonadotrophins (FSH and LH)

Question 8

What is hysterosalpingography (HSG) used to screen for?

Answer 8

Tubal occlusion

Question 9

What could increased body fat, decreased muscle mass and loss of pubic, axillary and facial hair in men suggest?

Answer 9

Androgen deficiency

Question 10

What is one of the most common causes of primary hypogonadism with impaired spermatogenesis?

Answer 10

Klinefelter syndrome - characterised by sex chromosome aneuploidy
Often have very small testes and almost always have azoospermia

Question 11

What is azoospermia?

Answer 11

When the semen contains no sperm

Question 12

What are the three groups of ovulation disorders?

Answer 12

Group I
Group II
Group III

Question 13

POI

Answer 13

Primary ovarian insufficiency

Question 14

Group I ovulation disorders

Answer 14

Hypothalamic pituitary failure (hypothalamic amenorrhoea or hypogonadotrophic hypogonadism)

Question 15

Group II ovulation disorders

Answer 15

Hypothalamic-pituitary-ovarian dysfunction (predominately polycystic ovary syndrome)

Question 16

Group III ovulation disorders

Answer 16

Ovarian failure (POI)

Question 17

Group I ovulation disorders treatment

Answer 17

Increasing body weight if BMI of less than19 and/or
moderating their exercise levels if undertake high levels of exercise
Pulsatile administration of gonadotrophin-releasing hormone or gonadotrophins with luteinising hormone activity to induce ovulation

Question 18

What are the signs/symptoms of polycystic ovary syndrome?

Answer 18

Androgen excess (hirsutism/excess testosterone)
Infrequent periods (anovulation)
Polycystic ovaries (USS)

Question 19

What is clomiphene?

Answer 19

Selective oestrogen receptor modulator - works similarly to oestrogen to stimulate ovulation in women who produce eggs but do not ovulate

Question 20

What is endometriosis?

Answer 20

Where endometrium starts to grow in other places, such as ovaries and fallopian tubes

Question 21

Causes of azoospermia

Answer 21

Testicular

Post testicular

Question 22

Testicular causes of azoospermia

Answer 22

Normogonadotrophic
Hypogonadism
Hypergonadotrophic

Question 23

Post testicular causes of azoospermia

Answer 23

Iatrogenic
Congenital
Infective

Question 24

What is intracytoplasmic sperm injection?

Answer 24

Injection of mature eggs with single sperm

Incubation overnight