Reproductive - Subfertility & Assisted Conception Flashcards
What is the most common cause of subfertility?
Male factor subfertility
What are the three groups of female factors causing subfertility?
Anovulation, tubal disease, uterine/peritoneal disease
What are some examples of commonly used ‘drugs’ which can cause semen abnormalities?
Alcohol and nicotine
When should subfertility be investigated?
When couples have not conceived after one year of regular unprotected sex
In a couple with subfertility, investigations are carried out in the female to establish what two things?
Is she ovulating, and are the Fallopian tubes patent
In a couple with subfertility, investigations are carried out in the male to establish what?
That the semen is of sufficient quality
A mid-luteal phase progesterone concentration of greater than what confirms that a woman is ovulating?
30nmol/L
When should a progesterone measurement be taken in order to confirm that a woman is ovulating?
7 days before the next expected period
Measurements of gonadotrophins and sex hormones should be taken at what stage in the menstrual cycle when investigating subfertility in a female?
Days 2-5
In addition to gonadotrophins and sex hormones, what other hormones should be measured when investigating both males and females for subfertility?
TFTs and prolactin
High testosterone and a high LH: FSH ratio in a woman with subfertility suggests what underlying diagnosis?
PCOS
High FSH and low anti-Mullerian hormone in a woman with subfertility suggests what problem?
Low ovarian reserve
When investigating for subfertility, what infection should a woman’s immunity status be checked for, and she should be vaccinated against if not immune?
Rubella
What infection should always be tested for when investigating both males and females for subfertility?
Chlamydia
What imaging investigation is used to diagnose abnormalities of the ovaries and uterus in women with subfertility?
Transvaginal US
When investigating a woman for subfertility, if uterine abnormalities are suspected or found on ultrasound imaging, what investigation should be done next?
Hysteroscopy
How should tubal patency be confirmed in low risk women (i.e. those with no history of pelvic infection/disease or abdominal surgery)?
Hysterosalpingography (HSG)
What side effect do many women experience after an HSG investigation?
Period like cramps
How should tubal patency be confirmed in high risk women (i.e. those with a history of pelvic infection/disease or abdominal surgery)?
Laparoscopy and dye
What investigation is the gold standard test for confirming tubal patency in women with subfertility?
Laparoscopy and dye
How long should a male abstain from ejaculation from before providing a semen sample?
3-4 days
If there is a reduction in any variable tested in a semen sample, what is the next step?
Repeat the sample in 3 months time
Couples with subfertility are advised to have sex how often?
2-3 times per weeks throughout the menstrual cycle
What are some lifestyle measures that are advised in both men and women with subfertility?
Stop smoking, cut back alcohol, lose/gain weight as appropriate
All women aiming to get pregnant should take which supplement?
Folic acid
What is the treatment for subfertility if semen analysis is normal, tubal patency has been confirmed and the female partner has a BMI < 30?
Ovulation induction
If a patient is amenorrhoeic, what should be done before starting ovulation induction?
Progesterone challenge test
What is the first line ovulation induction agent?
Clomifene citrate
When in the menstrual cycle is clomifene citrate given?
Days 2-6
What type of drug is clomifene citrate?
Anti-oestrogen
What are some fairly common side effects of clomifene citrate?
Hot flushes and labile mood
Treatment with clomifene citrate should be stopped if what symptoms develop?
Severe headache or visual disturbance
How is treatment with clomifene citrate monitored?
Regular transvaginal ultrasound scans
What surgical treatment option is available for ovulation induction in women with PCOS?
Ovarian drilling
Other than clomifene citrate, what are some other medications that can be used for ovulation induction?
Gonadotrophins and metformin
Tubal surgery is only offered to women under what age?
37 years
How are women with moderate-severe tubal disease with subfertility managed?
Assisted conception
In the UK, do individuals who donate their sperm or oocytes to help others conceive have the right to remain anonymous?
No
What age should the female partner be at the beginning of assisted conception treatment?
< 40 years
What age should the female partner be at the time of frozen embryo transfer in assisted conception?
< 41 years
In order to be eligible for assisted conception, couples must have been infertile for how long?
2 years
What are the rules regarding sterilisation and assisted conception?
Neither partner can have been sterilised
What are the rules regarding smoking and assisted conception?
Both partners must be non-smoking for at least 3 months pre-treatment and during treatment
What are the rules regarding alcohol and assisted conception?
Neither partner should drink alcohol prior to or during the treatment
What are the rules regarding previous children and assisted conception?
Couples are eligible if one partner has no biological children
How many cycles of assisted conception will a woman aged < 40 years recieve?
Three
How many cycles of assisted conception will a woman aged 40-42 receive?
One
Which type of assisted conception is this describing: fast moving spermatozoa are separated from sluggish ones and injected directly into the uterus after ovulation?
Intra-uterine insemination
What is the single greatest predictor of success in IVF?
The woman’s age
What is the overall success rate for IVF?
25%
What medication is used first in the ovarian hyperstimulation phase of IVF to achieve pituitary downregulation and prevent premature ovulation?
GnRH agonist
In the ovarian hyperstimulation phase, after a GnRH agonist has been given, what medication is given next to stimulate follicular growth and development?
Daily FSH or hMG injections
During the ovarian hyperstimulation phase of IVF, when should transvaginal ultrasound scans be taken?
On day 8, and every 2 days thereafter
During the ovarian hyperstimulation phase of IVF, when should the beta hCG injection be given?
When one leading follicle reaches 18mm and two further follicles are 16mm+
In the ovarian hyperstimulation phase of IVF, what medication is given to replicate the LH surge and trigger ovulation?
Beta hCG
In IVF, when is ultrasound guided transvaginal oocyte recovery carried out?
34-36 hours after hCG administration
A maximum of how many embryos can be transferred into the uterus in IVF treatment?
Two
What medication is given as luteal phase support in IVF treatment?
Progesterone supplements
How long is progesterone given for as luteal phase support in IVF?
10 weeks
When should women who are undergoing IVF treatment take a pregnancy test?
After two weeks of progesterone supplementation
In surrogacy, the surrogate cannot hand over legal parental responsibility until the child is how old?
6 weeks
What is the most significant risk of assisted conception to the mother?
Ovarian hyperstimulation syndrome
What are the three main risk factors for the development of ovarian hyperstimulation syndrome?
Low BMI, PCOS, younger age
What are some examples of significant complications of ovarian hyperstimulation syndrome?
Pericardial/pleural effusion, ascites, intravascular volume depletion
How is ovarian hyperstimulation syndrome managed?
Fluids, thromboprophylaxis and drainage of fluid collections
What is the most significant risk of assisted conception to the foetus?
Multiple pregnancy and its associated risks
