INFERTILITY

Question 1

Define infertility

Answer 1

The absence of pregnancy in a woman of reproductive age after one year of unprotected sexual intercourse without a known cause of infertility

Question 2

Name some causes of infertility

Answer 2

Unexplained
Ovulatory disorders
Tubal damage
Male factors
Uterine or peritoneal factors
Combined male and female

Question 3

Name some male factors which may lead to infertility

Answer 3

Hypogonadotrophic hypogonadism
Idiopathic semen abnormalities
Ejaculation issues
Varicocele
Tumours
Undescended testicles
Obstructive azoospermia
Infection

Question 4

Name some risk factors for infertility

Answer 4

Smoking
Caffeine
Alcohol
Raised BMI (>30)
Low BMI (<19)
Tight fitting underwear (mixed evidence regarding this)

Question 5

Investigations for infertility (men)

Answer 5

Seminal fluid analysis
LH
FSH
Free serum testosterone
Prolactin (if indicated ? prolactinoma)

Question 6

Investigations for infertility (women)

Answer 6

Day 21 progesterone
LH
FSH
Prolactin
Free serum testosterone (if ? PCOS)
Serum oestradiol
TFTs (if clinically indicated)

Transvaginal US

Hysterosalpingogram (HSG)
Hysterosalpingo contrast sonography (HyCoSy)
Diagnostic laparoscopy + tubal dye test

Question 7

Name five predictors of IVF success

Answer 7

Female age
Number of previous treatment cycles
Previous pregnancy history
BMI
Lifestyle factors

Question 8

WHO reference values for semen analysis?

Answer 8

Semen volume: 1.5ml or more
pH: 7.2 or more
Sperm concentration: 15 million spermatozoa per ml or more
Total sperm number: 39 million spermatozoa per ejaculate or more
Total motility: 40% or more
Vitality: 58% or more live spermatozoa
Sperm morphology: 4% or more

Question 9

How should the following causes of infertility be managed?

Male hypogonadotrophic hypogonadism
Obstructive azoospermia

Answer 9

Male hypogonadotrophic hypogonadism - gonadotrophin drugs

Obstructive azoospermia - surgical correction

Question 10

How should the following causes of infertility be managed?

Group I ovulation disorders (ie hypothalamic pituitary failure)
Group II disorders (eg hypothalamic-pituitary-ovarian dysfunction)

Answer 10

Group I ovulation disorders (ie hypothalamic pituitary failure) - GnRH
Group II disorders (eg hypothalamic-pituitary-ovarian dysfunction often PCOS) - clomifene or metformin or a combination of the two

Question 11

When may intrauterine insemination be appropriate?

Answer 11

People unable to have vaginal intercourse due to a physical or psychosexual problem
HIV +ve or hepatitis +ve patients
People in same sex relationships

Question 12

What is the incidence of infertility in the UK?

Answer 12

1 in 7 couples

Question 13

Name some female factors which may lead to infertility

Answer 13

PID
Premature ovarian failure
Uterine polyps
Endometriosis
Fibroids
Adhesions
Previous ectopic pregnancy
Congenital malformations

Question 14

According to current UK law how long can an embryo be grown for?

Answer 14

Up to 14 days

Question 15

According to current UK law how long can eggs be frozen for?

Answer 15

Up to 10 years

Question 16

What is the difference between Preimplantation Genetic Diagnosis (PGD) and Preimplantation Genetic Screening (PGS)?

Answer 16

PGD - looking for a known familial genetic disorder

PGS - looking for embryos at risk of aneuploidy as opposed to a specific disorder

Question 17

When may ICSI (intracytoplasmic sperm injection) be clinically indicated?

Answer 17

Low sperm count
Poor sperm motility
Abnormal morphology 
Anti-sperm antibodies
Previous vasectomy
Erectile dysfunction

Question 18

Aside from ejaculation, how may sperm be collected for artificial insemination?

Answer 18

PESA (Percutaneous Epididymal Sperm Aspiration)

TESA (Testicular Sperm Aspiration)

Question 19

When may PESA be indicated?

Answer 19

If the vas deferens is absent or blocked

Question 20

When may TESA be indicated?

Answer 20

If there is an absence of sperm in the epididymis or the epididymis is obstructed