Session 7 - Group Work

Question 1

Suggest what proportion of young couples have regular unprotected sex might be
expected to conceive within a year?

Answer 1

75%

Question 2

In Western European populations, what proportion of primary infertility is due to
problems with the male partner?

Answer 2

Around 30%

Question 3

List the possible points in the female reproductive system where problems may lead to
infertility. Write beside each the approximate proportions of women in which each type
of problem is identified as the cause

Answer 3

Failure to ovulate 28%
Fallopian tube problems 22%
Uterine problems 11%
Cervical problems 3%

Question 4

What is the normal range of volume in a single ejaculate?

Answer 4

2-4ml

Question 5

What is the normal range of sperm count (millions/ml)?

Answer 5

20-200 million.ml-1

Question 6

What other factors are assessed in semen analysis?

Answer 6

motility and morphology

Question 7

He says he has no problems with sexual performance, but on occasions men suffer
erectile dysfunction. From your knowledge of the structure and function of the male
system what are the likeliest causes of erectile dysfunction in young men?

Answer 7

Psychological
Endocrine (e.g., diabetes)
Neurological
Alcohol

Question 8

What is the physiological basis of drugs designed to improve erectile function?

Answer 8

Increase penile blood flow

Question 9

What is the normal range of length of menstrual cycle?

Answer 9

21-35 days

Question 10

f you know the date that a menstrual bleed began, how would you most accurately
calculate when the previous ovulation had occurred?

Answer 10

14 days before. Life of corpus luteum

Question 11

Which hormone provides evidence that ovulation has occurred? When, relative to the
onset of a menstrual bleed should you measure it, and in what body fluid?

Answer 11

Progesterone 
Day 21 (at peak of progesterone curve) in blood

Question 12

Why is it useful to keep a daily record of body temperature on rising in the morning?
Why does the temperature have to be taken at the same time each day?

Answer 12

Progesterone elevates basal temperature
Circadian rhythm of body temperature will confuse results if not same time of
day

Question 13

What is the difference between primary and secondary amenorrhoea?

Answer 13

Primary – never had periods
Secondary – cessation of periods after they have begun (after a 3 month
cessations of menses)

Question 14

What are the two commonest causes of secondary amenorrhoea and what hormone
tests will you use to distinguish them?

Answer 14

Pregnancy – Human chorionic gonadotrophin

Fall in body weight – Gonadotrophin levels

Question 15

Hyperprolactinaemia may lead to infertility. What clinical sign may indicate a diagnosis
of hyperprolactinaemia?

Answer 15

Production of small quantities of milk

Question 16

Look back a session or two, what drug could be used to treat hyperprolactinaemia. How
does it work?

Answer 16

Bromocryptine

Dopamine agonist – mimics effects of prolactin inhibitory hormone

Question 17

How, in principle, might you test whether uterine tubes are patent

Answer 17

Passage of radio-opaque dye from uterine cavity, hysterosalpingography

Question 18

What particular feature in a patient’s history might lead you to suspect that the uterine
tubes could be blocked?

Answer 18

Previous pelvic infection

Question 19

What properties of cervical mucus facilitate sperm survival and transport?

Answer 19

Alkalinity, lowered viscosity

Question 20

How might you establish whether cervical sperm transport is disturbed?

Answer 20

Post coital test – collect cervical mucus soon after copulation

Question 21

How in principle would you set about inducing ovulation in a woman whose cycles are
anovulatory? Suggest which types of drugs or hormones might be used and why.

Answer 21

Use an anti-oestrogen to reduce inhibition of FSH & LH e.g., clomiphene given for a few days
prior to expected time of ovulation

Question 22

In polycystic ovarian syndrome (PCOS), exposure of follicles to androgens may lead to
inhibition of FSH, but not LH secretion. From what you know of the control of
gonadotrophin secretion, by what mechanism might FSH secretion be inhibited
selectively? Why might there be no LH surges in this condition?

Answer 22

Follicles may still secrete inhibin which selectively inhibits FSH, thus reducing FSH in respect to
LH (hence, ratio changed)

Androgens may suppress LH surges (consider the role of testosterone in the male which inhibits
LH release from the pituitary).

Question 23

What features of excess androgens may be present?

Answer 23

hirsutism (which can be blocked by anti-androgen therapy)

oily skin / acne

Question 24

Why is there an increased risk of endometrial malignancy in prolonged and untreated
PCOS?

Answer 24

Due to sustained oestrogen stimulation of the endometrium