Infertility & Assisted Conception

Question 1

What percentage of couples struggle with infertility?

Answer 1

1/6

Question 2

List 5 reasons why the demand for assisted conception is increasing

Answer 2

Increasing parental age
Increasing chlamydia
Male infertility increasing
Increased options for ART
Improved success rates

Question 3

Give 5 pieces of lifestyle advice for couples struggling to conceive:

Answer 3

Limit alcohol intake 
Stop smoking
Keep BMI 19-24
Cervical smears
No recreational drug use

Question 4

List the different fertility treatments available currently?

6 options

Answer 4

IVF
ICSI (intra-cytoplasmic sperm injection)
Intra-uterine-insemination (IUI)
Fertility preservation
Donor insemination Surrogacy

Question 5

What is down regulation?

Answer 5

This is when a synthetic gonadotrophin releasing hormone agonist allows precise timing for oocyte recovery

Question 6

What does ovarian stimulation do?

Answer 6

Stimulates follicular development

Question 7

What % of eggs fertilise normally in IVF?

Answer 7

60%

Question 8

What day of division is the fertilised egg transferred to the uterus?

Answer 8

Day 5

Blastocyte stage

Question 9

What must the patient take for “luteal support” after embryo transfer?

Answer 9

Progesterone suppositories for 2 weeks

Question 10

Define azoospermia

Answer 10

No sperm found in ejaculate

Question 11

Where is sperm aspiration carried out?

Answer 11

Epididymis - obstructive problem

Testicular tissue - non-obstructive problem

Question 12

What is significant about ICSI?

Answer 12

A single sperm is injected into the ovum - sperm does not penetrate by itself

Question 13

What is a serious complication of ART?

Answer 13

Ovarian Hyper Stimulation Syndrome

Question 14

What preventative methods are used against OHSS?

Answer 14

Lose dose protocol

Antagonist suppression

Question 15

What is the current success rate of ICSI?

Answer 15

35%

Question 16

Which ducts degenerate in male development?

Answer 16

Mullerian Ducts

Question 17

What ducts degenerate in female development?

Answer 17

Wolffian Ducts

Question 18

What stimulates the differentiation of male external genitalia?

Answer 18

Dihydrotestosterone

Question 19

What syndrome is an X-linked recessive disorder, responsible for having outward genitalia of a female but genetic make up of a male?

Answer 19

Androgen Insensitivity Syndrome

Testes do not descend in this condition and are better off removed when discovered

Question 20

What is cryptorchidism?

Answer 20

Undescended testes

Question 21

If patients testes have not descended by adulthood, what is the increase in their risk of cancer?

Answer 21

6x increased risk

Question 22

Where is testosterone produced?

Answer 22

Leydig Cells

Question 23

Where does spermatogenesis occur?

Answer 23

Seminiferous tubules

Question 24

Where do the matured sperm sit in the cells?

Answer 24

The centre

When taking biopsy, make sure to take sample from very centre

Question 25

What is the role of the sperm's acrosome?

Answer 25

This contains enzymes for penetrating the ovum | In the head of the sperm

Question 26

List the 6 roles of the Sertoli cells?

Answer 26

``` Forms blood testes barrier Provides nutrients Phagocytosis Secretes seminiferous fluid Secretes androgen-binding globulin Secretes inhibin and activin ```

Question 27

Where does LH act in the males?

Answer 27

Leydig cells | Regulates testosterone production

Question 28

Where does FSH act in males?

Answer 28

Sertoli cells | Enhances spermatogenesis

Question 29

Where is the most common site of obstruction in males?

Answer 29

Vas deferens

Question 30

Before beginning fertility treatment, what medication should you have the woman on?

Answer 30

Folic acid | 0.4mg daily from preconception up until 12 weeks gestation

Question 31

When would a woman be on 5mg of folic acid instead?

Answer 31

Obese | or if increased risk of neural tube defect

Question 32

How do you assess the ovarian reserve?

Answer 32

Antral follicle count Or Anti-Mullerian hormone

Question 33

What vaccine should you check a woman has before fertility treatment?

Answer 33

Rubella | If not - immunise

Question 34

What is the optimal BMI for both males and females undergoing fertility treatment?

Answer 34

19-29

Question 35

How is intra-uterine insemination carried out?

Answer 35

Prepared semen is inserted into the uterine cavity around the same time as ovulation The cycle can be stimulated or can occur naturally

Question 36

What are some of the indications for intra-uterine insemination?

Answer 36

Same sex couple Abandoned IVF Blood borne virus

Question 37

What are the main indications for IVF treatment?

Answer 37

>2 years no conception unexplained Pelvic disease Anovulatory infertility (failed induction) Failed intra-uterine insemination (after 6 cycles)

Question 38

What is the tonic phase of folliculogenesis and how long does it last?

Answer 38

65 days | Primary and secondary follicles become antral follicles

Question 39

What is the growth phase of folliculogenesis and how long does it last?

Answer 39

20 days Antral follicles grow from 3-5mm to become pre-ovulatory follicles (20mm) Dependent on growth hormone

Question 40

What are some of the side effects of down regulation/

Answer 40

Hot flushes Mood swings Nasal irritation Headaches

Question 41

What 4 things is a sperm sample assessed for?

Answer 41

Volume Density (no. of sperm) Motility Progression

Question 42

What are some risks associated with oocyte collection?

Answer 42

Bleeding Pelvic infection Failure to get oocyte

Question 43

What temperature are human eggs stored at?

Answer 43

37 degrees

Question 44

What is a morula?

Answer 44

A 16 cell embryo

Question 45

At what stage does an embryo implant?

Answer 45

As a blastocyst

Question 46

When should you take a pregnancy test in the IVF process?

Answer 46

16 days after initial oocyte collection

Question 47

What are the main indications for ICSI?

Answer 47

Severe male infertility Previous failed IVF Preimplantation genetic diagnosis

Question 48

What hormones are secreted by a foetal testes, to cause the development of the male genital tract?

Answer 48

Testosterone | Mullerian Inhibiting Factor

Question 49

At what gestational age should there be external genitalia differentiation?

Answer 49

9 weeks | Can be seen on scan from 16 weeks

Question 50

What hormone, secreted by Sertoli cells, inhibits FSH?

Answer 50

Inhibin

Question 51

What hormone, secreted by Sertoli cells, activates FSH secretion?

Answer 51

Activin

Question 52

What is the zonal reaction'?

Answer 52

Prevents multiple sperm from fertilising the egg

Question 53

Where does fertilisation typically occur?

Answer 53

Ampullary region of the fallopian tube

Question 54

What are the clinical features of an obstructive male infertility problem?

Answer 54

Normal testicular volume Normal secondary sexual characteristics May have absent vas deferens Normal LH, FSH and testosterone

Question 55

What are some of the clinical features of a non obstructive cause of male infertility?

Answer 55

Low testicular volume Reduced secondary sexual characteristics Vas deferens present High LH FSH +/- low testosterone

Question 56

What can be given to a man suffering from infertility due to a hyperprolactinaemia ?

Answer 56

Cabergoline