Infertility

Question 1

How many couples report infertility problems?

Answer 1

1 in 7

Question 2

About what percentage of couples generally conceive within a year if woman is under 40 and they dont use contraception?

Answer 2

80%

Question 3

What should be asked in a female history in investigation for infertility?

Answer 3

• Duration of infertility
• Previous contraception
• Fertility in previous relationships
• Previous in pregnancies and complications
• Menstrual history
• Medical and surgical history
• Sexual history
• Previous investigations
• Psychological assessment

Question 4

What should be looked at in a female examination in investigation for infertility?

Answer 4

• Weight
• Height
• BMI
• Fat and hair distribution
• Galactorrhoea
• Abdominal examination
• Pelvic examination

Question 5

What may be some female signs of androgen excess?

Answer 5

• Hirsutism

- Acanthosis nigricans

Question 6

What may be some causes of androgen excess in females?

Answer 6

• Nonclassic congenital adrenal hyperplasia (NCCAH)
• PCOS
• Androgen-secreting tumours (Ovarian/adrenal)
• Ovarian hyperthecosis

Question 7

What can be used in measurement of androgen excess in women?

Answer 7

• Clinical measurement (Ferriman Gallwey Score)

- Biochemical measurement (Testosterone/DHEASetc)

Question 8

What symptoms may fibroids present with?

Answer 8

• Pressure symptoms
• Period problems
• Infertility

Question 9

What investigations would be used for female infertility?

Answer 9

-Rubella immunity,
-Chlamydia
-TSH
-If periods are regular: Mid luteal progesterone
( 7 days prior to expected period);
-If periods are irregular please do day 1-5 FSH, LH, PRL, TSH, testosterone
-Pelvic US
-Physical examination
-Ovulation testing
-Tubal pregnancy test

Question 10

What investigation may be used as a reliable rest of tubal occlusion?

Answer 10

Hysterosalpingography (HSG)

Question 11

What should be asked in a male history in investigation for infertility?

Answer 11

Developmental questions
-Testicular descent, change in shaving frequency, Loss of body hair

Infections
-Mumps, STDs

Surgical history
-Varicocele repair
Vasectomy

Previous fertility

Drugs/environmental - Alcohol, Smoking, Anabolic steroids, Chemotherapy, Radiation< Recreational drugs

Sexual history - Libido Frequency,

Chronic medical illness

Question 12

What should be looked at in a male examination in investigation for infertility?

Answer 12

• Weight
• Height
• BMI
• Fat ans hair distribution (hypoandrogenism)
• Abdominal and inguinal examination
• Genital examination - Epididymis, Testes, Vas deferens, Varicocele.

Question 13

List some of the causes of epididymitis?

Answer 13

STDs
TB
Mumps

Question 14

What is a varicocele?

Answer 14

Dilatation of pampiniform plexus of spermatic veins

Question 15

What condition may result in azoospermia?

Answer 15

Klinefelter Syndrome

Question 16

When should referral be considered for infertility?

Answer 16

After 1 year of trying

Unless specific problems
-Period irregularity, PMH, Testicular problems,
Abnormal Tests
HIV/Hep B
Anxiety
Age 35-45 (Offer after 6 months)

Question 17

What are the three types of ovulatory disorder?

Answer 17

• Group I - Hypothalamatic pituitary failure (eg Hypothalamic amenorrhoea)
• Group II - Hypothalamic-pituitary-ovarian dysfunction (Mostly PCOS)
• Group III - Ovarian failure (POI)

Question 18

What are signs of PCOS?

Answer 18

• Androgen excess (Hirsutism, ^Testosterone)
• Infrequent periods
• Polycystic ovaries on US

Question 19

What is the mode of action of clomifene?

Answer 19

Selective estrogen receptor modulator - binds in Ant. Pit. -> ^FSH

Question 20

When may gonadotrophins be used in female infertility?

Answer 20

• No ovulation with clomifene

- Ovulation but no pregnancy

Question 21

What is done for unexplained infertility?

Answer 21

• Do not offer oral ovarian stimulation agents
• Advise to try to conceive for total of 2 years before IVF will be considered
• Offer IVF treatment

Question 22

What happens during IVF?

Answer 22

Eggs harvested from ovary
Eggs fertilised in lab with sperm
Embryos undergo cell divisions
Transfer into womb

Question 23

Roughly what percentage of births are due to IVF?

Answer 23

2%