investigation and treatment of infertility

Question 1

for the best chance of making a baby when should sexual intercourse occur

Answer 1

frequently or appropriately timed. in stressed couples frequent sex is better less forced

Question 2

what three things do you need to make a baby

Answer 2

sperm egg and a pathway

Question 3

what are the six physiological events required for conception

Answer 3

spermatogenesis, ovulation, intercourse, ejaculation, fertilistation, implantation

Question 4

define infertility by nice guidelines

Answer 4

a woman of reproductive age who has not conceived after one year of unprotected sexual intercourse

Question 5

considering a holistic approach what do healthcare professional have to bear in mind aiding couples with infertility

Answer 5

that not being successful in having children is causing psychological distress to couples

Question 6

what is the most significant factor in ability to have a child assuming sperm is fine

Answer 6

woman age for normal birth or ivf live birth

Question 7

what causes sub fertility

Answer 7

male factor, anovulation, tubal factor, unexplained ( not dectactable)

Question 8

how does smoke and alcohol effect fertility

Answer 8

alcohol effects sperm quality and smoking reduces sperm quality and woman fertility

Question 9

how does a bmi of 26 affect pregnancy

Answer 9

greater than 25 so reduced fertility in men and women

Question 10

when you take history of couple together what should you aim to find out (investigating infertility)

Answer 10

how long they are together, how long they been trying to conceive, smoking and alcohol, coital frequency(means how often you kweng)

Question 11

what do you find out specifically from a female when investigating infertility

Answer 11

occupation, sti ectopic pregnancy or surgery, period cycles, drugs, endometriosis??

Question 12

what do you find out specifically from a male when investigating infertility

Answer 12

occupation • testicular maldescent • trauma • infections – STI – mumps orchitis • surgery • drugs – therapeutic – recreational

Question 13

what are the basic investigations for infertility

Answer 13

ovulation, ovarian reserve, tubal patency and pelvic anatomy, semen fluid analysis

Question 14

how do you assess ovulation

Answer 14

ask about periods if they are regular then over 95% of women will have fine ovulation. also assess midluteal progesterone, urinary lh too

Question 15

what do you look for in semen analysis

Answer 15

concentration, motility, morphology

Question 16

what should the volume of semen be

Answer 16

1.5ml

Question 17

what proportion of sperm should be progressively motile

Answer 17

more than 40 per cent

Question 18

how do you assess tubal patency and pelvic anatomy 3 ways

Answer 18

laparoscopy and dye(GOLD STANDARD), hysterosalpingogram HSG, hysteron contrast sonogram (hycosy)

Question 19

what happens to ovarian reserve as woman ages

Answer 19

decline

Question 20

how can you tests ovarian reserve

Answer 20

early follicular fsh, antral follicle count afc, amh, not

Question 21

An elevated early follicular FSH level can suggest what in woman

Answer 21

depleted ovarian follicular pool

Question 22

what is a drawback of AFC

Answer 22

looks at an image for follicles so inter observer variability, not good for pregnancy prediction

Question 23

list some of the other investigation you would do into infertility aside from the main basic ones

Answer 23

Day 2-4 hormone profile – FSH, LH, prolactin, TSH, testosterone • Rubella • cervical smear • Chlamydia swabs • Viral serology (Hep B, Hep C, HIV)

Question 24

Infertility clinics often have long waiting lists, when can you get early refferal

Answer 24

• female age 35 years or above
• Low ovarian reserve
• amenorrhoea / oligomenorrhoea
• suspected tubal factor
• suspected male factor

Question 25

What can cause tubal damage

Answer 25

sti, ectopic pregnancy, endometriosis, surgery

Question 26

how is anovulation classified

Answer 26

three groups, group one hypothalamus pituitary failure, group two hypothalamic pituitary ovarian dysfunction, ovarian failiure

Question 27

what is a gonadotroph

Answer 27

hormone that acts on gonads

Question 28

what causes male subfertility

Answer 28

sti, trauma , drugs,

Question 29

what are the two processes called in which sperm can be stored

Answer 29

percutaneous epididymal sperm aspiration, testicular sperm extraction

Question 30

what is HFEA and why are they needed

Answer 30

HUMAN FERTILISATION AND EMBRYOLOGY AUTHORITY (HFEA).
• The regulation of infertility treatment in the UK is undertaken by the HFEA, which was established following the Human Fertilisation and Embryology Act 1990.

Reflects public and professional concern about the implications assisted reproduction on human life and family relationships

Question 31

which family structures often raise concerns about potential child welfare if born through ivf

Answer 31

single parent families. -same sex parents. -Older parents. -Families in which one or both parents are not genetically related to their children.