Infertility

Question 1

Where is the hypothalamus found?

Answer 1

Lateral wall of the 3rd ventricle

Question 2

Where is GnRH secreted from in the brain and what is the pattern of release?

Answer 2

Hypothalamus, decapeptide, pulsatile fashion every 90 minutes

Question 3

What 6 glycoproteins are released from the anterior pituitary?

Answer 3

FSH, LH, Prolactin, TSH, GH, ACTH

Question 4

What 2 peptide hormones are released from the posterior pituitary?

Answer 4

ADH and oxytocin

Question 5

Purpose of FSH and LH?

Answer 5

FSH helps follicle development and LH helps ovulation and convert graffian follicle into corpus luteum

Question 6

Where does the oestrogen get released from in a developing follicle?

Answer 6

granulosa cells surrounding oocyte

Question 7

How does oestrogen act to reduce FSH production?

Answer 7

Negative feedback which produces inhibin to oppose FSh release

Question 8

What happens when oestrogen converts from a negative feedback loop to a positive one?

Answer 8

Day 12 surge in LH and FSH causing ovulation on day 14

Question 9

Purpose of LH in secretory phase?

Answer 9

Corpus luteum development caused by lutenisation

Question 10

What is the actual cause of menstruation?

Answer 10

Fall in progesterone

Question 11

How is the corpus luteum maintained in pregnancy?

Answer 11

HCG from trophoblastic and placenta cells

Question 12

During pregnancy how long is it till the corpus luteum is no longer needed?

Answer 12

7 weeks

Question 13

Common causes of infertility?

Answer 13

Azoospermia, tubal, endometriosis, ovulatory

Question 14

‘COST’ investigation areas?

Answer 14

Coitus, ovulation, sperm, tubal

Question 15

What questions should you ask about the sex in infertility?

Answer 15

Frequency, timing, ED

Question 16

What questions should you ask a women to see if she is ovulatin?

Answer 16

Mucus changes, mid cycle pain, regular cycles, PMS

Question 17

PCOS symptoms?

Answer 17

irregular menses, hirtuism, acne, weight gain, polycystic ovaries, LH:FSH ratio reversed

Question 18

What drug can be given to induce ovulation in PCOS?

Answer 18

CLOMID

Question 19

Symptoms of hyperprolactinaemia?

Answer 19

Galactorrhoea, amenorrhea, oestrogen deficiency

Question 20

In hyperprolactinaemia what will the FSH, LH, oestrogen levels be?

Answer 20

All low

Question 21

What dopamine agonist can be given to treat hyperprolactinaemia?

Answer 21

Bromocriptine

Question 22

What will the FSH and oestrogen levels be like in premature ovarian failure?

Answer 22

High FSH and low oestrogen

Question 23

When is FSH measured in the cycle to check for anovulation?

Answer 23

DAy 3 of cycle

Question 24

WHat day of the cycle is progesterone tested?

Answer 24

Day 21 - mid luteal

Question 25

What level of progesterone symbolises that the patient is ovulating?

Answer 25

Above 30

Question 26

How can USS help determine ovulation?

Answer 26

Can track follicle maturation, pre ovulatory are 18-20mm

Question 27

History questions to determine tubal patency?

Answer 27

PID, STDs, endometriosis, tubal surgery, cyclical pain, dyspareunia, ectopics, post abortion sepsis

Question 28

What investigations can you do into tubal patency?

Answer 28

Hysteroscopy, methylene blue dye test, hysterosalpingogram

Question 29

Usual presentation of endometriosis?

Answer 29

Dyspareunia, dysmenorrhoea, pelvic pain, gunpowder spots, endometrioma

Question 30

Define infertility

Answer 30

Inability to conceive after 1 year unprotected coitus

Question 31

What is varicocele?

Answer 31

Venous blood at higher temp trapped around testes

Question 32

What immunological abnormalities may be present in an infertile male?

Answer 32

Anti-sperm antibodies

Question 33

How do calcium channel blockers lead to infertility in males?

Answer 33

Decrease sperm ability to penetrate egg

Question 34

Chronic effect of STDs in males?

Answer 34

Epididymitis

Question 35

What can cause testicular dysgenesis syndrome?

Answer 35

consuming things like xenoestrogens

Question 36

What happens if testicular dysgenesis syndrome effects sertoli cells vs leydig cells?

Answer 36

sertoli - impaired sperm quality, leydig - congenital abnormalities caused by altered testosterone production

Question 37

What is usual concentration of semen?

Answer 37

20 million per ML

Question 38

What does ICSI stand for and when is it used

Answer 38

intracytoplasmic sperm injection for immobile sperm

Question 39

How can you tell if a man has azoospermia or obstructive azoospermia?

Answer 39

High FSH and LH in non-obstructive

Question 40

Investigations into male infertility

Answer 40

Chromosome analysis, endocrine (FSH,LH,Inhibin,testosterone), CF, anti sperm antibodies, hormone profile

Question 41

What does PESA stand for?

Answer 41

percutaneous epididymal sperm aspiration

Question 42

What is a TESE?

Answer 42

open testicular biopsy

Question 43

What is TESA? RIsks?

Answer 43

fine needle testicular sperm aspiration, architectural distortion

Question 44

What is TESET? what gauge needle?

Answer 44

testicular sperm extraction with Trucut needle, 14 gauge

Question 45

What is found within the eggs granulosa cells?

Answer 45

Zone pellucida

Question 46

What happens when sperm reaches zona pellucida?

Answer 46

hyperactivated, release enzymes from acrosome

Question 47

What 2 things can be given in ovulation dysfunction?

Answer 47

Clomid, FSH injections

Question 48

Difference between ICSI and TICSI?

Answer 48

Almost completely immobile sperm are taken directed from testes to be injected

Question 49

What does FET stand for?

Answer 49

Frozen embryo transfer

Question 50

What does GIFT stand for?

Answer 50

gamete intrafallopian transfer

Question 51

What does ZIFT stand for?

Answer 51

zygote intrafallopian transfer

Question 52

How do you initially take control of the menstrual cycle in IVF treatment?

Answer 52

Nasal spray to suppress GnRH release

Question 53

Once the menstrual cycle is controlled, what is given to the woman wanting to undergo IVF? what monitoring is performed?

Answer 53

FSH injections with USS monitoring of ovaries

Question 54

What is given to the woman 36 hours before egg collection in IVF?

Answer 54

HCG injection

Question 55

In IVF how long is the embryo grown for before reimplantation?

Answer 55

2-5 days (6-8 cells)

Question 56

Potential complications of IVF treatment?

Answer 56

OHSS, Multiple pregnancies, visceral damage or PID, fetal abnormality

Question 57

What can OHSS result in for the woman?

Answer 57

Increases permeability leading to pleural effusions, ascites, concentrated blood, blood clots!!

Question 58

How is the issue of multiple pregnancies combatted in a mother undergoing IVF?

Answer 58

if they are under 40 only implant 1 embryo of good quality

Question 59

Oligozoospermia?

Answer 59

Too few sperm

Question 60

Asthenozoospermia?

Answer 60

Not moving well

Question 61

Teratozoospermia?

Answer 61

Grossly abnormal sperm

Question 62

Azoospermia?

Answer 62

No sperm in ejaculate

Question 63

Difference between oligozoospermia and azoospermia?

Answer 63

Oligo is too few sperm and azoo is no sperm in ejaculate

Question 64

Why do you take the FSH level on day 2/3 of a womans normal cycle before initiating IVF?

Answer 64

To see if they will respond to the FSH injections

Question 65

What FSH levels suggests the woman will be unresponsive to IVF?

Answer 65

over 14 IU/l

Question 66

What FSH level suggests that a woman will be responsive to IVF treatment?

Answer 66

Below 8 IU/l

Question 67

What is the purpose of giving a women serum AMH before IVF?

Answer 67

response shows how likely the woman is of having oHSS

Question 68

What is the age limit for receiving donor eggs?

Answer 68

50