Infertility and Assisted Conception

Question 1

1. Define infertility
2. How common is infertility?
3. What is the difference between primary and secondary infertility?

Answer 1

1. Inability to conceive after 12 months regular intercourse without contraception.
2. Occurs in 1/6 couples
3. Primary- never been pregnant
   Secondary- been pregnant before

Question 2

1. How long is a regular menstrual cycle?
2. What are the two phases of the menstrual cycle and what occurs on day 1?
3. How long does bleeding usually last?

Answer 2

1. 28-35days
2. follicular phase and luteal phase, 1st day of bleeding.
3. 3-8 days

Question 3

1. What is the difference between oligomenorrhoea and amenorrhoea?
2. What hormone triggers ovulation? What hormone peaks afterwards?
3. What is the best test to assess ovulation? What is easily used by patients

Answer 3

1. Oligomenorrhoea- >35 days
   amenorrhoea- no menstruation
2. LH surge, progesterone peaks afterwards
3. Midluteal serum progesterone test, LH surge detectors

Question 4

1. Identify some initial investigations of infertility.

2. Identify possible further investigations

Answer 4

1. Day 21 progesterone: establish ovulation, TSH, Rubella immunity, Chlamydia screen, Ensure cervical smear up to date, Diagnostic semen analysis
2. Female ultrasound, Hysterosalpingogram (HSG) for tubal/pelvic defects, Hysteroscopy

Question 5

What is meant by the following:

1. Azoospermia
2. Asthenozoospermia
3. Oligozoospermia
4. Teratozoospermia

Answer 5

1. No sperm in ejaculate
2. % motile sperm below limit
3. Total number/conc sperm too low
4. % morphologically normal sperm below reference limit.

Question 6

1. Identify some pieces of lifestyle advice for infertility patients

Answer 6

1. Stop smoking
BMI 18.5 – 30
Reduce / stop alcohol consumption
Moderate caffeine
Stop recreation drugs / methadone
Folic acid

Question 7

The following are all criteria for what treatment?
Stable relationship 2y (incl same sex)
Female age <40yrs (<42yrs)
Female BMI 18.5 – 30
Non-smokers (at least 3/12 pre-treatment)
No biological child
No illegal / abusive substances (incl methadone)
Neither partner to have been sterilised
Duration unexplained infertility 2y
Up to 3 cycles treatment

Answer 7

IVF/ICSI