Infertility

Question 1

What is the definition of infertility?

Answer 1

12mnth+ of regular unprotected sex w/o conceiving

Question 2

What is the difference between primary and secondary infertility?

Answer 2

Primary - never conceived

Secondary - miscarried or ectopic pregnancy

Question 3

What is the biggest factor affecting chance of concieving?

Answer 3

Increasing female age

Question 4

What STI is associated with reduced fertility?

Answer 4

Chlamydia

Question 5

At what age does fertility in females start to decrease?

Answer 5

Roughly 28

Question 6

Endometriosis is assoc. w/ infertility. T/F?

Define endometriosis

Answer 6

T

Endometrial lining found outside the womb

Question 7

What endocrine condition is assoc. with erectile dysfucntion?

Answer 7

Diabetes

Question 8

What genetic condition is associated with absent vas deferens?

Answer 8

CF - leads to male infertility

Question 9

What vaccination should females be checked to make sure they have in infertility clinic as catching this when pregnant can cause problems for the baby?

Answer 9

Rubella - need to sustain for trying to get pregnant for 4 weeks after

Can lead to rubella syndrome

Question 10

What investigation can be done to test for tubal patency ?

Answer 10

HSG - hysterosalpiniogram

Question 11

How is male infertility investigated?

Answer 11

Sperm count

Question 12

What effect does obesity have on miscarriage?

Answer 12

Increases risk

Question 13

What BMI should patients aim on to improve fertility chances?

Answer 13

18.5-30

Question 14

Couple come to clinic worried about fertility as they have been trying to time sex with menstural cycle peaks and have been trying for 6 months.

How can they be reassured?
What should they be advised?

Answer 14

90% conceive within 1 year + 94% in 2nd year

Have sex every 2-3 days

Question 15

How should folic acid be prescribed?

Answer 15

400ug/daily prior to pregnancy and for first 12 weeks

5mg/daily

• diabetic
• neural tube defect
• BMI >30

Question 16

What is hydrosalpinx?

Answer 16

Fluid build up in the fallopian tube

• can flush away any embryo
• fluid can also contain chemotoxic agents

Question 17

What abnormalities can be found in the reproductive tract that can cause implantation problems?

What should be done about them?

Answer 17

Septum
Polyps
Fibrous tissue
Fibroids (bengin lump in wall of womb)

Majority need removal/splitting etc.

Question 18

What type of fibroid is more likely to have an impact on fertility? Submucosal or subserosal or intermural

Answer 18

Submucosal/intermural

Submucosal and intermural face into the womb and affect implantation

Subserosal (sit on outer wall) don’t come into womb so shouldn’t have a problem

Question 19

Following a septum resection hysteroscopic surgery, it is important that patients endometrial lining recovers.

What hormone thickens/promotes angiogenesis of the endometrium?

Answer 19

Oestrogen

Patients given 6 weeks of oestrogen treatment post surgery

Question 20

When is intracytoplasmic sperm injection indicated?

Answer 20

When males have a low sperm count

Question 21

If males have no sperm production, what management option can be suggested?

Answer 21

Donor sperm

Question 22

When measuring female hormones during investigation why is progesterone measured on day 21?

Answer 22

A rise in progesterone suggests ovulation has taken place

Question 23

IVF vs ICSI fertilisation methods?

Answer 23

IVF - allowed to fertilise naturally in dish

ICSI - sperm injected into oocyte

Question 24

What stage does fertilisation have to reach before inserted back into woman?

Answer 24

Blastocyst

Question 25

What lifestyle changes must someone undergo to get fertility treatment on the NHS?

Answer 25

• stop smoking
• BMI <30
• no recreational drugs
• minimal alcohol use