Infertility

Question 1

Differential diagnoses of amenorrhoea

Answer 1

Pregnancy 
PCOS 
Premature Ovarian Failure 
Pelvic Inflammatory Disease 
Hyperprolactinaemia

Question 2

Define primary infertility

Answer 2

never conceived before

Question 3

Define secondary infertility

Answer 3

have previously conceived e.g. miscarriage, ectopic…

Question 4

causes of infertility

Answer 4

tubal disease 
male factor infertility 
unexplained 
endometriosis 
ovulatory disease

Question 5

Define subfertility

Answer 5

Failure to conceive despite regular unprotected sexual intercourse over 12 months in the absence of known reproductive pathology

Question 6

factors influencing fertility

Answer 6

female age
duration of infertility
previous pregnancy
cause of infertility

Question 7

infertility is common, true or false

Answer 7

true 15%

Question 8

history taking

Answer 8

infertility history 
gynae and andrology 
sexual history 
SH 
PMH and surgery 
Obstetric history

Question 9

examination

Answer 9

BMI, BP, urinalysis
general exam
pelvic exam and USS in female
urogenital exam in male

Question 10

investigations for females

Answer 10

chlamydia and gonorrrhoea swab
cervical smear
blood for rubella immunity
midluteal progesterone level (7 days prior to last day of cycle)

Question 11

progesterone >__nmol/L is suggestive of ovulation

Answer 11

30nmol/L

Question 12

if progesterone is low and there is an anovulatory cycle,

Answer 12

FSH, oestrogen, LH

Question 13

rubella immunity level

Answer 13

> 10 U/L IgG Ab

Question 14

congenital rubella syndrome features

Answer 14

rash
microcephaly
PDA
cataracts

Question 15

MMR booster vaccine

Answer 15

live vaccine

avoid conception for 4 weeks

Question 16

Chlamydia can cause…?

Answer 16

PID 
tubal disease/block
tubo-ovarian abscess 
peritonitis 
Fitz-Hugh-Curtis syndrome 
chronic pelvic pain 
infertility 
ectopic pregnancy 
ciliary damage in uterine tube

Question 17

symptoms of chlamydia

Answer 17

asymptomatic 
vaginal discharge 
PCB 
spotting 
dysuria

Question 18

consequence of PID

Answer 18

hydrosalpinx = damaged tube full of toxic fluid

asymptomatic but detected on imaging

Question 19

regular menstruation is strongly suggestive of ovulation, true or false

Answer 19

true

Question 20

commonest cause of anovulation

Answer 20

PCOS

Question 21

Rotterdam criteria is for what

Answer 21

PCOS

Question 22

Ovulation induction

Answer 22

Anti oestrogens:
clomifene citrate - taken in day 2-6 of cycle, can cause dual egg release
tamoxifen
Aromatase inhbitor:
letrozole - causes mono-ovulation, taken from day 2-6

Question 23

2nd line ovulation induction

Answer 23

clomifene + metformin
gonadotrophin therapy injections (FSH + LH)
laparoscopic ovarian diathermy

Question 24

causes of male infertility

Answer 24

multifactorial:
obstructive - vasectomy, infection, CF
non-obstructive - undescended testes, orchitis, torsion, chromosomal
idiopathic

Question 25

management of male infertility

Answer 25

surgery for obstructed vas deferens
IUI
ICSI
donor sperm insemination

Question 26

sperm retrieval

Answer 26

Percutaneous testicular sperm aspiration

MESA - microsurgical epidydimal sperm aspiration

Question 27

tubal investigation

Answer 27

HSG
laparascopy
adhesiolysis

Question 28

what is endometriosis

Answer 28

presence of endometrial glands and stroma outwith the uterine cavity

Question 29

Turner’s syndrome chromosome analysis

Answer 29

45XO
ovarian dysgenesis - can’t get eggs
oocyte donation required