Management of Infertility

Question 1

what is the general lifestyle advice for fertility?

Answer 1

stop smoking
achieve BMI 18.5-30
reduce/stop alcohol
caffeine in moderation
stop recreational drugs
stop taking methodone

Question 2

how can an overweight mother affect pregnancy?

Answer 2

increased rates of fertility problems
increased rate of miscarriage
reduced success with fertility treatment

Question 3

how much weight loss can have improve pregnancy outcome?

Answer 3

5-10%

Question 4

how can being overweight affect fertility in men?

Answer 4

9 kg weight increase can cause fertility problems

increased rates of erectile dysfunction

Question 5

life cycle of sperm and egg?

Answer 5

sperm = 48 hrs
egg = 24 hrs

Question 6

primary care management of infertility?

Answer 6

full history and examination

advice

Question 7

what vitamin supplements are used in pregnancy and why?

Answer 7

folic acid - 400micrograms daily before pregnancy and throughout first 12 weeks
- 5mg daily pre and early stages of pregnancy if any parent has neural tube defect, previous baby with neural tube defect, family history of neural tube defect or diabetes
10 micrograms of Vit D pere day for pregnancy and lactating women in groups at risk of vit D deficiency

Question 8

what is rubella syndrome?

Answer 8

group of physical abnormalities in an infant as a result of maternal infection and subsequent fetal infection with rubella virus
rash at birth
low birth weight
small head
heart abnormalities
visual problems
bulging fontanelle

Question 9

how can you tell if immune or non-immune to rubella?

Answer 9

rubella IgG antibodies 6U/L = non immune

Question 10

what is done if the mother has chalmydia?

Answer 10

azithromycin 1mg stat

if macrolide allergic - doxycycline 100mg bd for 7 days

Question 11

what is a good indicator of present ovulation?

Answer 11

regular menstruation

irregular cycles can indicate oligo/anovulation

Question 12

what can cause group 1 ovulatory disorders?

Answer 12

hypothalamic disorder
stress
excessive exercise
anorexia
kallmans syndrome
isolated gonadotrophin deficiency

Question 13

what are the findings in group 1 ovulation disorders?

Answer 13

low FSH
low oestrogen levels
normal prolactin
negative progesterone challenge

Question 14

which groups of ovulation disorders can be managed via ovulation induction?

Answer 14

groups 1 and 2

Question 15

what are group 2 ovulation disorders? give some examples of features

Answer 15

hypothalamic pituitary dysfunction
e.g PCOS
normogonadotrophic
normal oestrogen
anovulation

Question 16

what are group 3 ovulatory disorders and what are the findings?

Answer 16

ovarian failure

high gonadotrophins with low oestrogen

Question 17

high or low prolactin can cause ovulatory disorders?

Answer 17

high

Question 18

what are the 2 forms of reproductive surgery?

Answer 18

primary surgical treatment for infertility

surgery to enhance IVF outcome

Question 19

which conditions can be managed by primary surgery for infertility?

Answer 19

pelvic adhesions
grade 1 and 2 endometriosis
chocolate cysts in ovary
tubal block

Question 20

how is surgery to improve IVF success performed?

Answer 20

laparoscopy
hysteroscopy
- no place for laparotomy

Question 21

how is tubal disease managed?

Answer 21

mild = tubal surgery
proximal tubal obstruction = salpingography + tubal catheterisation or hysteroscopic tubal cannulation
hydrosalpinges = salpingectomy (preferably before laparoscopy) before IVF

Question 22

what is hydrosalpinx?

Answer 22

fluid build up in fallopian tubes causing obstruction

causes reduced pregnancy rates and increased miscarriage rates

Question 23

how can hydrosalpinx be managed?

Answer 23

laparoscopic salpingectomy
hysteroscopy
…………

Question 24

when is tubal occlusion used as management for hydrosalpinx and what is done?

Answer 24

if laparoscopy is contraindicated

hysteroscopic essure made of nickel is used to block the tubeal ostea and gets covered by tissue in a few weeks

Question 25

how is endometriosis managed?

Answer 25

laparoscopic removal of endometriotic cyst

- helpful before fertility treatment

Question 26

nice guidelines for endometriosis management?

Answer 26

minimal/mild = surgical ablation or resection of endometriosis + laparoscopic adhesiolysis
ovarian endometriosis = laparoscopic cystectomy
moderate/severe = surgical treatment

Question 27

management of polyps?

Answer 27

myosure polypectomy

Question 28

how can uterine septum be managed?

Answer 28

meteroplasty

Question 29

how are women with amenorrhoea who are found to have intrauterine adhesions managed?

Answer 29

hysteroscopic adhesiolysis (improves chance of pregnancy)

Question 30

what are fibroids?

Answer 30

benign lump in wall of uterus
low growing
can affect fertility

Question 31

what are the 4 types of fibroid?

Answer 31

pedunculated (attached to the uterine wall via a stalk)
submucous (originate in uterine wall and bulge into uterine cavity)
intramural (inside wall)
subserous (outside uterus/outer wall of uterus, shouldn’t interfere with fertility so don’t need to remove it)

Question 32

how is a fibroid inside the wall of the uterus managed?

Answer 32

if more than 5cm
submucosal = hysteroscopical treatment
intramural = if more than 5cm, laparoscopic myomectomy
subserosal = no treatment needed

Question 33

what are the steps in IVF treatment?

Answer 33

pre-IVF work-up >stimulate ovaries > monitor cycle > ovulation induction > oocyte retrieval > preparation of sperms > in vitro fertilisation > embryo transfer > luteal support

Question 34

at what point is the embryo implanted back into the uterus?

Answer 34

day 5 - blastocyst?

Question 35

what is the initial predictor of IVF success?

Answer 35

age

>42 = basically no chance of success