Infertility ☺️

Question 1

What is infertility

What are the common causes

Answer 1

People of reproductive age who have not conceived after 1 year of unprotected sex

• anovulation
• tubal
• male
• unexplained (most common)

Question 2

Ovulatory status

• tracking
• testing and imaging

Answer 2

Cycle patterning
-regular, likely to be ovulating (most reliable measure)

Ovarian reserve measurements

• AFC (egg quantity)
• count in USS, reflects no left in follicular phase

AMH (egg quantity)
-produced by granuloma cells

FSH

• increased = depleted pool
• normal FHS doesn’t tell you anything useful

Maternal age
-best indicator of quality

Question 3

Tubal issues

• common causes
• investigations

Answer 3

Laparoscopy and dye GOLD STANDARD
-v invasive

HSG - Xray and contrast

Hycosy - USS

Infection
Surgical adhesions
Ectopic pregnancy
Endometriosis

Question 4

What are the 3 groups of anovulation

Which is the most common

Answer 4

Group 1

• hypothalamic issue
  
  • amenorrhea, hypoGnRH)

Group 2
-HPO issue (MOST COMMON, PCOS)

Group 3
-ovarian insufficiency

Question 5

What 4 things would you measure in semenalysis?

Answer 5

Volume
Density
Motility
Morphology

Question 6

What are the 2 types of azoospermia

-Why do they occur

Answer 6

Obstructive - normal testes, FSH

• infection
• vasectomy
• no ductus deferens

Nonobstructive - small testes, increased FSH
-testicular failure/impaired spermatogenesis

Question 7

What is PCOS
What is the pathophysiology behind it
How would you manage PCOS

Answer 7

Faulty HPO axis
-irregular ovulation, low FSH

Ovulation induction

• clomiphene citrate => increase GnRH
• letrozole => block O prod => increase FSH
• gonadotrophins

Question 8

How would you manage infertility

Answer 8

Assisted conception

• eggs removed via aspiration, bypass tubal damage
• many sperm try to fertilize egg => implantation

ICSI

• 1 sperm injected directly into egg
• sperm aspirated/surgically extracted

HFEA
-regulates storage, donation, use of gametes, embryos