Session 7 - Infertility

Question 1

Define infertility

Answer 1

is the failure to conceive within 1 year

Question 2

How many couples does infertility effect?

Answer 2

15%

Question 3

What is primary infertility?

Answer 3

No previous pregnancy

Question 4

What is secondary infertility?

Answer 4

Previous pregnancy, successful or not

Question 5

How often is infertility the mans fault?

Answer 5

20-25% cases

Question 6

How often is infertility the woman’s fault?

Answer 6

45-60% cases

Question 7

What is a normal semen analysis?
Volume
Sperm count
Motility
Morphology

Answer 7

Volume >2ml
Sperm count >20 million/ml
Motility >50%
Morphology >50%

Question 8

What are three main causes of male infertility?

Answer 8

o	Abnormal sperm production
   	Testicular disease
o	Obstruction of ducts
   	Infection, vasectomy
o	Hypothalmic / Pituitary dysfunction

Question 9

What are the three main causes of anovulation in females?

Answer 9

o Hypothalmic
 Hyperprolactinaemia, weight loss, exercise, stress
o Pituitary
 Pituitary tumours, necrosis
o Ovarian
 Ovarian failure, menopause, radiotherapy, chemotherapy

Question 10

How can you differentiate between causes of anovulation?

Answer 10

Hormone levels

Question 11

Give hormone levels in menopause
LH
FSH
Oestrogen

Answer 11

Give hormone levels in
LH high
FSH high
Oestrogen low

Question 12

Give hormone levels in ovarian failure
LH
FSH
Oestrogen

Answer 12

Give hormone levels in
LH high
FSH high
Oestrogen low

Question 13

Give hormone levels in
LH
FSH
Oestrogen

Answer 13

Give hormone levels in
LH low
FSH low
Oestrogen low

Question 14

Give hormone levels in
LH
FSH
Oestrogen

Answer 14

Give hormone levels in
LH increased ratio
FSH increased ratio
Oestrogen normal

Question 15

Give three ways in which ovulation can be induced

Answer 15

o	Anti-oestrogen
   	Reduce negative feedback to hypothalamus / pituitary
   	Increase GnRH
   	Increase FSH
o	Gonadotrophins
   	FSH administration
o	GnRH Agonists
   	Pulsatile to mimic secretion

Question 16

Give two causes of tubal occlusion

Answer 16

Sterilisation

PID

Question 17

Give two methods of diagnosing tubal occlusion

Answer 17

 Laparoscopy

 Hysterosalpingogram

Question 18

Give two treatments for tubal occlusion

Answer 18

 Tubal surgery

 Assisted conception

Question 19

Give four main features of polycystic ovarian syndrome

Answer 19

o Increased androgen secretion
o Raised LH/FSH ratio
o Insulin resistance
o Multiple small ovarian cysts

Question 20

Give four major questions to be asked of couple presenting with infertility

Answer 20

o	Regular, unprotected intercourse?
o	Ovulating?
   	Regular menstrual cycle?
   	Day 21 Progesterone?
o	Patent Tubes
   	History of infection / sterilisation
   	Hysterosalpingogram
o	Adequate sperm count?

Question 21

Give three treatments for anovulation

Answer 21

o	Induce ovulation
o	Overcome tubal occlusion by surgery or IVF
o	If inadequate sperm then
   	Artificial insemination by donor
   	Intra-cytoplasmic sperm injection