Infertility

Question 1

What is the objective definition of infertility?

Answer 1

Inability of a couple to conceive after 1 year of trying

given: normal monthly fecundability

Question 2

What are the indications for investigating infertility

Answer 2

1. > 35 years old with no pregnancy
2. Oligo/amenorrhea
3. Tubal obstruction
4. Uterine disease
5. Severe endomentriosis
6. Known male factor

Question 3

[Semenalysis]

In preparation for semenalysis, the patient is advised to abstain from ejaculation for ___

Answer 3

2 to 3 days

Question 4

[Semenalysis]

The semen profile reflects sperm production which occurred ____

Answer 4

3 months earlier

Question 5

[Semenalysis]

What are the normal values of semenalysis?

Answer 5

Volume 1.5mL
Concentration 15 million/mL
Total number 39 million/ejaculate
Total motility 40%
Progressive motility 32%
Normal forms 4%

Question 6

How many times will you repeat semenalysis?

Answer 6

2

Question 7

For women older than 35 years old, serum FSH and estradiol should be obtained on ___

Answer 7

cycle day 2

Question 8

A decreased ovarian reserve has a FSH value of _____

Answer 8

FSH >10miU/mL

A FSH of >20miU/mL, bad prognosis

Question 9

An estradiol level of _____ independently suggest a decreased prognosis regarding ovarian reserve

Answer 9

> 70pg/mL on Day 2 or 3

Question 10

What will be your next step once the workout for ovulation and semenalysis is normal

Answer 10

Do a HSG in the follicular phase of the next cycle

Question 11

What are the indications of HSG?

Answer 11

1. History of salpingitis

2. Tenderness on pelvic exam

Question 12

What is the prophylactic drug prior to HSG?

Answer 12

Doxycycline for 1 week

100mg BID x 4 days starting 1 day before the procedure

Question 13

What is the first line treatment of anovulation

Answer 13

Clomiphene Citrate

competes with estrogen-binding sites on hypothalamus; increase FSH and increase E2

Question 14

What is an adjunct treatment for anovulation

Answer 14

Metformin

induces ovulation through reducing insulin resistance adn directly stimulates the ovary

1500mg/day

Question 15

____ is a drug that inhibits estradiol production during the5 days of administration

Answer 15

Letrozole

negative feedback increases LH:FSH ration

2.5mg or 5mg for 5 days beginning on cycle days 3 to 5

Question 16

___ drug that is used for ovulation when estrogen levels are low <30pg/mL

Answer 16

gonadotropins

monitor E2 and UTZ after 5 days then every other day until follicle reaches 18mm

Question 17

What are the indications for IVF?

Answer 17

1. bilateral tubal occlusion

2. Severe male factor