Infertility

Question 1

What is the medical definition of infertile?

Answer 1

A couple unable to conceive after 12 months of regular intercourse without the use of contraception. 1 in 7 Couples have fertility issues. 80% of couples should conceive in the first year of trying.

Question 2

What are the 4 main physiological barriers to fertility?

Answer 2

• Availability of Eggs - Availability of Sperm - Can gametes meet? - Can embryo implant?

Question 3

Things to ask females who are worried that they are infertile (4)

Answer 3

• Previous contraception - Menstrual history - Sexual history - Previous pregnancies, complications and fertility in previous relationships.

Question 4

What is the clinical measurement for androgen excess in females?

Answer 4

Ferriman Gallwey Score

Question 5

What are the biochemical measurements that check for androgen excess in females?

Answer 5

• Testosterone - DHEAS >700mcg/dL (Follow up with Adrenal CT looking for androgen-secreting tumour) - 17-OH Progesterone

Question 6

What is Acanthosis Nigricans?

Answer 6

A sign of androgen excess.

Question 7

What things do we look for in the Pelvic Examination?

(5)

Answer 7

• Masses
• Pelvic Distortion
• Tenderness
• Vaginal Septum
• Cervical Abnormalities

Question 8

What are the main 3 types of fibroids?

Answer 8

Submucous

Intramural

Subserosal

Question 9

What findings are in concordance with fibroids?

Answer 9

• Pressure Symptoms
• Period Problems
• Infertility

Question 10

What are the baseline investigations for females?

Answer 10

• Rubella Immunity
• Chlamydia
• TSH
• Mid-Luteal progesterone (7 days prior to period)
• Irregular Period investigations (day 1-5):
  
  • FSH
  • LH
  • PRL (Prolactin)
  • TSH
  • Testosterone

Question 11

What are the baseline investigations for males?

Answer 11

Semen Analysis

Question 12

What investigations are carries out in a fertility clinic?

Answer 12

• Pelvic Ultrasound
• Physical examination
• Ovulation testing
• Semen analysis
• Tubal patency test`

Question 13

What questions should be asked in an infertile male’s history?

Answer 13

• Developmental
  
  • Testicular Descent
  • Change in shaving frequency
  • Loss of Body hair
• Infections
  
  • Mumps
  • STDs
• Surgical
  
  • Varicocele Repair
  • Vasectomy
• Previous cases of infertility

Question 14

What are the main causes of epididymitis?

Answer 14

• STDs
  
  • Chlamydia trachomatis
  • Gonorrhoea
• Semineferous Tubular Necrosis (Disrupting spermatogenesis)
• TB & Mumps

Question 15

What equipment do you use to identify size of testes / cyst / tumour?

Answer 15

Orchidometer

Question 16

What is CBAVD?

Answer 16

Congenital

Bilateral

Absence of

Vas

Deferens

Question 17

What is Group I ovulatory disorder?

Answer 17

Hypothalamic Pituitary Failure

(known as hypothalamic amenorrhoea / hypogonadotrophic hypogonadism)

Question 18

What is Group II ovulatory disorder?

Answer 18

Hypothalamic-Pituitary-Ovarian dysfunction.

(Polycystic ovary syndrome)

Question 19

What is Group III ovulatory disorder?

Answer 19

Ovarian Failure

(Primary Ovarian Insufficiency)

Question 20

What can you offer Group I ovulatory disorder sufferers to induce ovulation?

Answer 20

• Pulsatile administration of GnRH
• GnH + LH
• BMI <19
  
  • Moderate excercise levels
    
    • Eat more

Question 21

What are the symptoms of Group I ovulatory disorders?

Answer 21

• Low body weight
• Stress/Excercise related amenorrhoea
• Craniopharyngioma (or other tumours that effect the hypothalamus)
• Kallmann’s Syndrome (Amenorrhoea with anosmia)

Question 22

What is hydrosalpinges?

Answer 22

When the fallopian tube is blocked and fills with serous or clear fluid near the ovary. This may present as distention.

Question 23

Why would we offer salpingectomy to women before in vitro fertilisation?

Answer 23

Laparoscopy salpingectomy for women with hydrosalpinges before IVF has been shown to improve the chance of a live birth.

Question 24

What are the types of Azoospermia?

Answer 24

Question 25

What is azoospermia?

Answer 25

Azoospermia is the medical condition of a man whose semen contains no sperm.

Question 26

List the 4 reasons as to why IVF will be offered:

Answer 26

• Ovulation
  
  • Clomifene
  • Gonadotrophins
• Male
  
  • ​Intrauterine Insemination (IUI)
  • Donor Insemination (DI)
• Tubal
  
  • ​Surgery
• Unexplained
  
  • ​IUI
  • Superovulation

Question 27

What is Intracytoplasmic Sperm Injection (ICSI)?

Answer 27

Injection of mature eggs with single sperm.

Then incubation overnight.