Infertility & Pharmacological Treatment

Question 1

How many couples have difficult conceiving?

Answer 1

1 in 7

This is around 3.5 million people in the UK

Question 2

What is the likelihood of pregnancy occurring within the next year is a couple has been trying to conceive for more than 3 years?

Answer 2

25% or less

Question 3

What are the 2 types of infertility?

Answer 3

1. primary infertility

2. secondary infertility

Question 4

What is primary infertility?

Answer 4

When someone who has never conceived a child in the past has difficulty conceiving

Question 5

What is secondary infertility?

Answer 5

When someone has had one or more pregnancies in the past, but is having difficulty conceiving again

Question 6

What are the 3 causes of infertility?

Answer 6

1. female causes - 45%
2. male causes - 30%
3. unexplained infertility - 25%

Question 7

What are the 3 main female causes of infertility?

Answer 7

1. ovulation disorders
2. uterus and fallopian tube disorders
3. age

Question 8

What is an ovulation disorder?

Answer 8

When something causes women to stop releasing eggs entirely

Question 9

What are examples of uterus and fallopian tube disorders?

Answer 9

This is when the uterus or fallopian tubes are damaged

e.g. scarring from surgery, endometritis, fibroids, infections (STIs)

Question 10

When does the biggest decrease in fertility occur?

Answer 10

During the mid-thirties

Question 11

What are the 3 main male causes of infertility?

Answer 11

1. semen
2. ejaculation disorders
3. alcohol

Question 12

How can problems with the semen lead to infertility?

Answer 12

1. decreased number of sperm or none at all
2. decreased mobility
3. abnormal morphology

Question 13

When will a couple be referred for treatment?

Answer 13

1. of reproductive age
2. not conceived after 1 year of unprotected vaginal sexual intercourse
3. in the absence of any known cause of infertility

Question 14

What are the pre-treatment guidelines for increasing chances of fertility?

Answer 14

1. reduce alcohol
2. stop smoking
3. avoid caffeinated beverages
4. reduce BMI to below 30 (men and women)
5. increase BMI to above 19
6. avoid tight underwear
7. folic acid supplementation

Question 15

What investigations are involved after referral for treatment?

Answer 15

1. semen analysis
2. assessment of ovulation
3. look for tubal damage and uterine abnormalities
4. screening for infections such as chlamydia

Question 16

What are the 3 broad categories of treatment for infertility?

Answer 16

1. medical treatment
2. surgical treatment
3. assisted reproduction techniques - IVF/ICSI

Question 17

What are the medical and surgical treatments offered to women?

Answer 17

1. drugs for ovulation induction

2. laparoscopy for ablation of endometriosis/unblock tubes

Question 18

What are the medical and surgical treatments offered to men?

Answer 18

1. erectile/ejaculatory dysfunction drugs

2. surgical correction of tube blockage or sperm retrieval

Question 19

What are the 6 stages involved in IVF?

Answer 19

1. pre-treatment e.g. lifestyle factors, weight loss/gain
2. down regulation of women’s hormones
3. ovarian stimulation encourages eggs to grow
4. egg and sperm retrieval
5. embryo transfer
6. early pregnancy support (may involve progesterone)

Question 20

what are the risks of IVF?

Answer 20

1. multiple pregnancy
2. psychological impact - can lead to marital discord and increased depression in women
3. social impact
4. ethics