sub fertility

Question 1

effect of obesity on fertility

Answer 1

half chance of donor insemination
risk of miscarriage
risk of anovulatory fertility
fertility treatment is less likely to work
increased complications in pregnancy

Question 2

affect of smoking on fertlity for women

Answer 2

brings forward menopause 1-4 years
infertility 2x as common
ectopic pregnancy
requires more stimulation for IVF
half chance of IVF treatment success
increased risk of miscarriage

Question 3

effect of smoking on fertility for men

Answer 3

increased impotence
semen parameters are impaired
halves IVF treatment success
risk of miscarriage and fetal anomaly
risk of childhood malignancy

Question 4

define infertility

Answer 4

1 year of unprotected sex
affects 1/6 couples
after a further year 50% will conceive naturally

Question 5

causes of infertility

Answer 5

structural: tubal, chlamydial or secondary to other pelvic inflammation eg. appendix
ovarian: either anovulatory due to PCOS or poor ovarian reserve, rarely due to hypogonadotropic hypogonadism or weight-related amenorrhea
pelvic pathology
male causes
unexplained

Question 6

investigation for infertility

Answer 6

laparoscopy with contract to check if the tubes are open
swabs for chlamydia, GC
US: hydrosalpinx

Question 7

treatment

Answer 7

distal hydrosalpinx: laproscopic salpingostomy
if large hydrosalpinx: salpingectomy and IVF
severe disease: surgery not indicated

Question 8

fibroids

Answer 8

types: intramural, intracavity, summucosal
most infertility related to intracavity

Question 9

treatment for fibroids

Answer 9

GnRH: you can only use this for 6 months due to risk of bone loss, can reduce size up to 50%
US-guided microwave ablation: focusses energy onto the fibroids and cook it
uterine artery embolisation: starve it (cases of sepsis)