Lecture 18 - Infertility

Question 1

Roughly 1 in ____ couples of reproductive age will experience infertility and need help to conceive.

Answer 1

8

an equal number of men and women have infertility

Question 2

After trying for 1 year, the chance of pregnancy declines to ____%

Answer 2

<10%

Question 3

What can accelerate ovarian reserve decline?

Answer 3

chemo/radiation
surgery
smoking
genetic (Fragile X premutation, Turner’s syndrome, FHx of premature menoapuse)

Question 4

Infertility definition

Answer 4

as the inability to conceive after 1 year of unprotected intercourse

Question 5

When do you refer to fertility clinic?

Answer 5

<35 if regular cycles and no pregnancy of 1 year

35-39 if regular cycles and no pregnancy after 6 months

40+ if regular cycles and no pregnancy after 3 months

sooner if:
irregular cycles
known hx of PCOS, endometrirosis, tubal ligation, 2+ miscarriages

Question 6

How can you tell if a women is ovulating?

Answer 6

are her periods regular?
moliminal sxs (breast tenderness, bloating, acne)
check progesterone, day 3 tests, thyroid panel, free/total testosterone, prolactin, BMI, mid-cycle US

Question 7

What tests should be run fo initial assessment of infertility?

Answer 7

Post ovulation:
-progesterone >3ng/ml mid-luteal phase

Day 3 of menses:

• estrogen
• FSH
• LH
• AMH (anti-mullerian hormone)

Imaging
Day 3:
-US (typically want to see 10-15 follicles)

Question 8

SIS

Answer 8

saline infusion sonohysterography

infusion of saline into the uterus while performing an US allows better visualization of the uterine cavity

polyps, fibroids, adhesions, uterine septum

Question 9

HSG

Answer 9

hysterosalpingogram

insertion of contrast dye (gadolinium) into the uterus and fallopian tubes followed by an xray to check uterine contour and the patency of the tubes

causes of tubal factor:

• STI/PID
• ruptured appendix
• prior pelvic surgery - adhesions
• endometriosis

Question 10

What are the different components are semen analysis?

Answer 10

ejaculation volume
sperm concentration
total sperm number
total motility
progressive motility
normal morphology

Question 11

What are causes of male infertility?

Answer 11

varicocele 
infection
ejaculation issues
cryptochidism
hormone imbalances
medical conditions 
chromosomal abnormalities

Question 12

When is the best time to get pregnant?

Answer 12

1-2 days prior to 1 day after ovulation

having sex every other day after menses has highest rate of pregnancy

Question 13

Why doesn’t OPK work in PCOS?

Answer 13

ovulation predictor kits are designed to detect LH surge

PCOS have consistently elevated baseline LH

Question 14

What is the window of ovulation for the egg?

Answer 14

it has 24 hours

LH surge usually 1 day prior to ovulation

Question 15

How long can sperm survive in the reproductive tract?

Answer 15

2-3 days

Question 16

Clomid

Answer 16

(clomiphene citrate)
selective estrogen receptor modulator (SERM)

can be used with timed intercourse or IUI cycles

SERM thins the lining and decreases vaginal mucous

risk of multifollicular development

typically first line treatment for ovulatory disorders

Question 17

Femara

Answer 17

Ietrozole

aromatase inhibitor (suppresses estrogen production) 
less likely to have multifollicular development 

higher live birth rate in women with PCOS, especially with higher BMI

Question 18

OHSS

Answer 18

ovarian hyperstimulation syndrome

mitigated by type of “trigger shot” and monitoring of estrogen levels
3rd spacing: bloating, abdominal fullness, n/v/d, weight gain, DVT/PE, SOB, pleural effusion