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MRCOG Subfertility > Sub-fertility > Flashcards

Sub-fertility Flashcards

1
Q

How common is sub fertility?

A

14% 1 in 7 couples

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2
Q

When does ovulation occur?

A

12-16 days before start of next period

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3
Q

What % of couple will concieve following 1 year & 2 year of regular unprotected intercourse?

A

1 year 84%
2 year 92%

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4
Q

When should someone be referred if not conceived with IUI?

A

After 6 cycles

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5
Q

Whe should someone be referred following regular unprotected sexual intercourse?

A

1 year of sexual intercourse or earlier if
>36 years or
known clinical cause of sub fertility

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6
Q

What % subfertilty caused by male and female factors?

A

Male 20-30%
Female 20-35%
Combine 25-40%

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7
Q

What % of sub fertility is no cause found?

A

10-20%

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8
Q

What is the most common cause of female infertility?

A

Ovulation dysfunction
21% of female infertility

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9
Q

How long to sperm survive in female reproductive tract?

A

7 days

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10
Q

What frequency of sexual intercourse optimises chance of becoming pregnant?

A

Sexual intercourse every 2-3 days

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11
Q

When trying to become pregnant how much alcohol can the woman/man have?

A

Woman - 1-2 units, 1-2 times per week
Man 3-4 units/day

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12
Q

A BMI of what cut off for men and women is associated with taking longer to conceive?

A

BMI 30

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13
Q

How can ovarian response to predicted gonadotrophin stimulation in IVF?

A
  1. Total astral follicle count on TVUS, Day 3 cycle
    - <4 low responded
    - >16 high responder
  2. AMH
    - <5.4 low responder
    - >25 high responder
  3. FSH
    - >8.9 low response
    - < 4 high response
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14
Q

Regular menus up to how many days are normally indicative of ovulation?

A

26-36 days

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15
Q

What blood test confirms ovulation?

A

Progesterone, 7 days before end of cycle.
Day 21 if 28 day cycle

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16
Q

WHO classification of ovulation disorders. What is group 1? What would be seen on blood?

A

Hypogonadotrophic hypogonadism

  • Low LH/FSH
  • Normal prolactin
  • Low oestrogen

10% ovulation

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17
Q

WHO classification of ovulation disorders. What is group 2? What would be seen on blood?

A

Hypothalamic pituitary dysfunction

1) LH/FSH abnormality
2) Normal oestrogen

85% ovulation disorders
PCOS

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18
Q

WHO classification of ovulation disorders. What is group 3? What would be seen on blood?

A

Ovarian failure

  1. High gonadotrophins
  2. Hypogonadism, low oestrogen

4-5% ovulation disorders

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19
Q

What % of sub fertility is caused by tubal factors?

A

14%

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20
Q

What % of tubal obstruction detected at HSG will be confirmed at laparoscopy?

A

38%

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21
Q

What % of tubal patency detected at HSG will be confirmed at laparoscopy?

A

94%

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22
Q

Who should HSG not be offered to?

A

PID
Previous ectopic
Endometriosis

Need more reliable test - HyCoSy or Lap & Dye

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23
Q

What imaging and what infection screening should be performed when Ix sub fertility?

A

USS pelvis
Viral status (HIV, Hep B, Hep C, Rubella)
Chlamydia

24
Q

For what infections can sperm washing be offered?

A

Hep C and HIV

25
When should sperm washing happen for HIV+ve male?
Not compliant with HAART Plasma viral load >50 Confection with other infection
26
What prophylaxis if given to women undergoing HSG
Doxycycline ot azithromycin
27
In unexplained sub fertility, what is chance of spont pregnancy with each menstrual cycle?
2-4% 15% in 1 year, 35% 2 years
28
Unexplained fertility, most important predictor of successful conception>
Age of woman
29
1st line treatment for unexplained sub fertility?
Expectant management for 2 years
30
When to offer IVF in unexplained sub fertility
After 2 years
31
When to offer IUI as alternative to vaginal sexual intercourse?
Difficulty sexual intercourse - physical/psychosexual Sperm washing Same sex
32
If no pregnancy following 6 IUI what should happen?
Assess ovulation, tubal patency, semen analysis If normal offer further 6 IUI
33
Low sperm count is found to be the cause of what % of sub fertility?
20% Contributory in further 25%
34
What % of WHO criteria for sperm quartity will be a false +ve, following 1 & 2 test?
1 test 10% false +ve 2 test 2% false +ve
35
How long should a repeat sperm count be sent?
3 months
36
If azoospermia or severe oligozoospermia, when should the repeat sperm count be sent?
2-4 weeks
37
What % of men with poor sperm quality if no cause found?
30-50%
38
What is the normal values on sperm count: Semen volume
>1.5ml
39
What is the normal values on sperm count: pH
>7.2
40
What is the normal values on sperm count: Spem concentration
>15 million per ml
41
What is the normal values on sperm count: Total number of sperm
>39 million per ejaculate
42
What is the normal values on sperm count: Total motility (progressive & non progressive)
>40 motile >32 progressive motility
43
What is the normal values on sperm count: Vitality
>58%
44
What is the normal values on sperm count: Sperm morphology
>4%
45
List causes of hypothalamic hypogonadism causes of male subfertiliy
Congenital - Kallman Acquire - pituitary lesion, hyperprolactinoma, anabolic steroids
46
Causes of non obstructive azoospermia (testicular), what is seen on Ix
Reduction in testicular size and elevated FSH Most common cause of male infertility Cryptorchidism Torsion Trauma Orchitis Chromosome disorders (Klinefelter’s syndrome, Y-chromosome microdeletions) Systemic disease Radiotherapy or chemotherapy Idiopathic (66%) → offer cryopreservation
47
List causes of obstructive azoospermia, what seen on tests?
Normal testes size, normal FSH - Congenital absence vans deference (CF) - Varicocele → also consider anejacualtion or retrograde ejaculation
48
How does myotonic dystrophy effect male fertility?
Testicular atrophy, primary hypogonadism - Oligo/azospermia - Impaired secondary sexual characteristics - Low testosterone, high FSH/LD
49
What is the medical treatment of male hypogonasotrophic hypogonadism?
FSH and hCG to stimulate spermatogenesis
50
What is the medical treatment of male anejacualtion?
Alpha-agonistic drugs Parasympathetic drugs
51
What can be offered to men with obstructive azoospermia?
Surgical correction of obstruction IVF/ICSI
52
Does surgical treatment of varicocele improve pregnancy rates?
No, do not offer
53
Which men are offered IVF/ICSI?
Azoospermia, oligosperma, unexplained infertility
54
Chances of successful prengnay with each cycle IVF?
15-20%
55

MRCOG Subfertility (19 decks)

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