infertility

Question 1

what Is the requirement for fertility?

Answer 1

• production of normal sperm
• production of normal eggs
• sperm traverse the female tract to reach the egg (capacitation)
• sperm penetrate and fertilise the oocyte

Question 2

what Is the clinical definition of infertility?

Answer 2

• failure to conceive after regular unprotected sexual intercourse for 2 years in absence of unknown reproductive pathology

Question 3

what are the factors which affect females?

Answer 3

• ovulatory disorders
• disorders of the female tract
• implantation, growth and development

Question 4

list some disorders of the female tract

Answer 4

• tubal obstruction–> consequence of pellucida;vic infection (STIs)–> scarring and adhesions in uterine tubes
• endometriosis –> ectopic growth go endometrial tissue in sites such as uterine tubes, ovaries or peritoneal cavity

Question 5

how can these female tract disorders be diagnosed?

Answer 5

• HSC , HyCOsy and laparoscopy imaging techniques

Question 6

what is a bicornate uterus?

Answer 6

• congenital anomaly
• uterus is divided
• partial or incomplete
• surgical removal

Question 7

what are uterine leiomyomas?

Answer 7

• these are benign smooth muscle tumours driven bu estrogen production -> common in obese people and during the menopause
• develop within the uterine wall

Question 8

which processes can male disorders affect?

Answer 8

• production of spermatozoa
• transport of spermatozoa through the male tract
• transmission to the female tract
• sperm function in female tract

Question 9

how are male problems diagnosed?

Answer 9

• through semen analysis or some via blood analysis to look at T, FSH and LH levels
• if no sperm levels –> genetic screening for Klinefelter syndrome

Question 10

if a patient is azoospermic ?

Answer 10

• there is no sperm in the ejaculate

Question 11

list some disorders affecting sperm production

Answer 11

• genetic disorders –> Y chromosome deletions
• deletion of AZF region (severity depends on deletion)
• cryptorchidism -> reduced spermatogenesis and increased risk of testicular cancer

Question 12

what prevents transport of sperm into the male tract?

Answer 12

• obstructive azoospermia (stops sperm reaching ejaculate) vs non-obstructive (sperm can reach
• post infection
• bilateral or vas deferens occlusion
• congenital absence of the VD (CBAVD)

Question 13

what is CBAVD?

Answer 13

• improper development of the VD
• thick mucus production
• impairs sperm transport in male tract
• linked to CFTR mutations

Question 14

how can failures in transmission of sperm occur?

Answer 14

• erectile dysfunction (1 in 10)

- ejaculatory dysfunction (retrograde ejaculation and defects in accessory glands)

Question 15

what happens during a normal ejaculation?

Answer 15

• Contraction of musculature of prostate, seminal vesicles and vas deferens => seminal fluid and sperm => urethra = emission
  
  • Contraction of urethral and pelvic floor musculature => ejaculation
  • Urethral sphincter closes bladder neck –> prevents urine ejaculation –> diabetes

Question 16

what occurs during retrograde ejaculation?

Answer 16

· Incompetence of urethral sphincter
• Ejaculation into the bladder
• Ejaculate volume nil or low
• Confirmation in urine sample–> sperm presence

Question 17

what is assisted conception?

Answer 17

• any technique which assists conception but does not cure the infertility

Question 18

why give clomiphene:?

Answer 18

• is an oral anti- estrogen
• removal of inhibition on HPG axis
• ## allows for increased FSH Levels

Question 19

what is IUI?

Answer 19

• injection of prepared sperm into uterine cavity

- must be washed as seminal plasma contains pGs which causes contractions

Question 20

why have IUI?

Answer 20

• if unable to have sexual intercourse
• need sperm washing
• in a same sex relationship
• allows bypassing of cervical mucus
• perfect timing stimulated or natural
• non-invasive

Question 21

when do patients undergo IVF? (in vitro fertilisation)

Answer 21

• major
• failed ovulation induction
• failed IUI
• tubal obstruction
• unexplained infertility

Question 22

what is ICSI

Answer 22

intracytoplasmic sperm injection –> injection of sperm into oocyte

• 50,100,000 sperm added and left to F

Question 23

why can we use both GnRH agonists and antagonists ?

Answer 23

• agonist there is initially a stimulatory flare followed by down regulation of GnRHR –> suppression of gonadotrophin release (take longer as there’s a flare first)
• antagonists -> immediate suppression of G release (are immediate acting)

Question 24

what are the risks associated with IVF and ICSI?

Answer 24

• Multiple pregnancies
• Very invasive for woman
• Ovarian Hyperstimulation Syndrome (OHSS)
○ excessive response to fertility drugs
○ multiple follicles produce VEGF – vascular
permeability – fluid accumulation in the
peritoneal/thoracic cavity
○ occasionally fatal
• Risk of congenital abnormalities/long-term maternal risks, imprinting disorders
• Inheritance of male infertility

Question 25

when do we have to use donated sperm/oocytes?

Answer 25

• Severe male factor infertility
• Premature ovarian failure, surgical loss of ovaries, poor
oocyte quality (maternal age)
Either/both partner carrier of heritable disease

Question 26

what is PGD used for?

Answer 26

• preimplantation genetic testing
• removal of one or two cells from early embryo for genetic analysis
• sex -linked diseases, translocations and single gene disorders such as Huntington’s