NICE Fertility problems: assessment and treatment Flashcards
What is the minimum reference value for semen volume according to WHO?
1.5 ml or more.
What is the normal pH level of semen based on WHO reference values?
7.2 or more.
What is the minimum normal sperm concentration per ml?
15 million spermatozoa per ml or more.
What is the reference value for total sperm number per ejaculate?
39 million spermatozoa per ejaculate or more.
What is the reference value for total motility in semen analysis?
40% or more motile OR 32% or more with progressive motility.
What is the minimum percentage of live spermatozoa (vitality) according to WHO?
58% or more.
What is the WHO reference value for sperm morphology (normal forms)?
4% or more normal forms.
What does a low semen volume suggest clinically?
Possible retrograde ejaculation, obstruction, or seminal vesicle dysfunction.
Why is it important to repeat a semen analysis if the first test is abnormal?
Because semen quality can fluctuate; confirmation is needed.
After how long should a repeat semen analysis ideally be performed if the first is abnormal?
3 months after the initial test.
Why should repeat semen analysis be delayed for 3 months after the first test?
To allow a full cycle of spermatogenesis (~74 days) to complete.
When should a repeat semen analysis be done sooner than 3 months?
If azoospermia or severe oligozoospermia is detected.
What is azoospermia?
Complete absence of sperm in the ejaculate.
What is severe oligozoospermia?
Very low sperm concentration, typically <5 million/ml.
Should screening for antisperm antibodies be offered routinely?
No, because there is no effective treatment to improve fertility.
What do antisperm antibodies do?
They impair sperm motility and fertilisation capacity.
What is the main purpose of semen analysis in fertility assessment?
To evaluate sperm quality and detect male factor infertility.
Can men with abnormal semen parameters still achieve natural pregnancy?
Yes, many men below reference ranges can still be fertile.
What is the best initial predictor of a woman’s fertility and IVF success?
A woman’s age.
What does Antral Follicle Count (AFC) measure?
The number of small (2–10 mm) follicles seen on transvaginal ultrasound, typically on day 3 of the cycle.
What AFC value suggests a low response to IVF stimulation?
An AFC of 4 or fewer.
What AFC value suggests a high response to IVF stimulation?
An AFC greater than 16.
What hormone is produced by ovarian follicles and used to assess ovarian reserve?
Anti-Müllerian Hormone (AMH).
What AMH value suggests a low response to IVF stimulation?
AMH ≤ 5.4 pmol/L.
What AMH value suggests a high response to IVF stimulation?
AMH ≥ 25.0 pmol/L.
On which day of the menstrual cycle should FSH be measured for ovarian reserve testing?
Day 3 of the menstrual cycle.
What FSH level suggests a low ovarian reserve (poor response)?
FSH > 8.9 IU/L.
What FSH level suggests a likely good ovarian response?
FSH < 4 IU/L.
Should AMH be measured on a specific day of the cycle?
No — AMH can be measured at any point in the menstrual cycle.
Name three tests that should NOT be used individually to predict fertility treatment outcome.
Ovarian volume, ovarian blood flow, inhibin B, and oestradiol (E2).
Why is age a crucial factor in fertility assessment?
Because both egg quantity and quality decline significantly with age.
What is the purpose of ovarian reserve testing in the context of IVF?
To predict the likely ovarian response to gonadotrophin stimulation for IVF.
What is the risk of a very high ovarian response in IVF (e.g., >20 oocytes)?
Ovarian hyperstimulation syndrome (OHSS) and cycle complications.
Why is serum progesterone measured in women undergoing infertility investigations?
To confirm whether or not ovulation is occurring.
What does a high serum progesterone level in the luteal phase indicate?
That ovulation has occurred — the corpus luteum is producing progesterone.
When should serum progesterone be measured in a 28-day cycle?
On day 21 of the cycle.
Why is day 21 chosen for serum progesterone testing in regular cycles?
Because ovulation usually occurs around day 14, and progesterone peaks about 7 days after ovulation.
Can regular menstrual cycles confirm ovulation without testing?
No — ovulation should still be confirmed with serum progesterone testing.
What should be done if a woman has irregular or long menstrual cycles?
Time the test based on estimated ovulation or repeat weekly until menstruation.
In a 35-day cycle, on which day should serum progesterone be tested?
On day 28 of the cycle.
How often should serum progesterone be tested in irregular cycles if ovulation timing is unclear?
Weekly until the next period starts.
What serum progesterone level strongly suggests ovulation?
Greater than 30 nmol/L.
What serum progesterone level suggests possible ovulation?
Between 16–30 nmol/L.
What serum progesterone level suggests anovulation?
Less than 16 nmol/L.
Why is it inappropriate to test on day 21 in women with irregular cycles?
Because day 21 may fall before ovulation and give a false low result.
What is the typical timing of ovulation in a 28-day menstrual cycle?
Around day 14.
What is the role of the corpus luteum in progesterone production?
It secretes progesterone after ovulation during the luteal phase.
