Module 1

Question 1

Rate of reproduction required for a population to replace itself

Answer 1

2.1 births per woman.

Question 2

Current global trends of fertility

Answer 2

Increasing longevity and declining fertility. Africa average 4.7 children per woman, Australia 1.9

Question 3

Define fertility

Answer 3

The reproductive capacity of an individual/couple. The reproductive capacity is assessed by whether pregnancy can occur and how long it takes to conceive.

Question 4

Define The total fertility rate

Answer 4

The average number of babies a woman could expect to bear - so long as fertility was normal and she didn’t die early.

Question 5

What are the 3 major factors the determine the chances of natural conception?

Answer 5

• Female age
• sperm quality
• duration of exposure a woman has to quality sperm

Question 6

Define Infertility

Answer 6

A disease of the reproductive system characterised by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.

Question 7

DEFINE PRIMARY INFERTILITY

Answer 7

When a woman is unable to ever bear a child, either due to the inability to conceive or carry a pregnancy to a live birth.

Question 8

DEFINE SECONDARY INFERTILITY

Answer 8

A woman who is unable to bear a child either by the inability to conceive or carry a pregnancy to a live birth following a previous pregnancy or live birth.

Question 9

4 Causes of female infertility

Answer 9

• Ovulation disorders: PCOS, hypothalamic dysfunction, hyperprolactinemia, premature ovarian insufficiency
• Tubal disease: Pelvic inflammatory disease, surgical complications, pelvic tuberculosis
  Endometriosis
• Anatomical factors: fibroids and other uterine abnormalities
  Immune factors such as antibodies to sperm and natural killer cell activity
  *Unexplained

Question 10

CAUSES OF MALE INFERTILITY

Answer 10

*Sperm production
* Blockage of sperm
* Sperm antibodies
* Sexual problems
* Hormonal problems

Question 11

What are the fertility investigations

Answer 11

Female: cervical smear test, urinalysis for chlamydia, blood test to measure progesterone, test for rubella, blood tests for FSH, LH and oestradiol around menstruation to check hormone imbalances, test for onset of menopause

Male: sperm check to test for abnormality (shape, size and motility), urine test for chlamydia

Question 12

Non-medical Fertility treatments

Answer 12

• Fertility awareness
• weight loss
• enhanced nutrition
• traditional Chinese medicine
• antioxidants

Question 13

Medical fertility treatments

Answer 13

• Natural or stimulated cycles/ovulation induction → egg collection → insemination and fertilisation → embryo transfer → luteal support → embryo freezing
• Donor gametes/insemination: the donor should be between 21-41 years old, ova donors should have already had a successful pregnancy and live birth
• Embryo donors from previous ART cycles
• Surrogacy

Question 14

Complications of fertility treatments

Answer 14

• surgical
• drug/allergy
• multiple embryos
• ovarian hyperstimulation syndrome
• cycle failures
• early pregnancy losses
• mental health impacts

Question 15

REACTION OF CLOMID, EFFECTS AND SIDE EFFECTS

Answer 15

Category in pregnancy: X
Indications: For the treatment of ovulatory dysfunction in women trying to conceive
Dose, route and frequency: An oral tablet should be taken starting at 50mg daily for 5 days, where ovulation does not occur a second cycle of 100mg daily for 5 days may be indicated.
Side effects; Bloating, stomach/pelvic pain, vision problems (blurry/double vision, seeing flashes, sensitive eyes), yellow eyes/skin, ovarian hyperstimulation syndrome, ovarian enlargement, chest pain, etc.

Question 16

OVARIAN HYPERSTIMULATION SYNDROME

Answer 16

• OHSS is a medical event of gross ovarian enlargement resulting in acute symptoms, which cam rapidly progress.
• Symptoms include gross ovarian enlargement, gastrointestinal symptoms, ascites, dyspnea, oliguria, and pleural effusion.
• association with pericardial effusion, anasarca, hydrothorax, acute abdomen, hypotension, renal failure, pulmonary edema, intraperitoneal and ovarian hemorrhage, deep venous thrombosis, torsion of the ovary, and acute respiratory distress.
• The early warning signs of OHSS are abdominal pain and distention, nausea, vomiting, diarrhea, and weight gain. Elevated urinary steroid levels, varying degrees of electrolyte imbalance, hypovolemia, hemoconcentration, and hypoproteinemia may occur.
• To minimize the hazard associated the lowest dose consistent with expected clinical results should be used.