Subfertility

Question 1

What should you advise people who are concerned about their fertility?

Answer 1

Vaginal sexual intercourse every 2-3 days optimises the chance of pregnancy

Question 2

What proportion of couples conceive in 1 year if the woman is under 40 and the have regular sex without contraception?

Answer 2

80%

Question 3

What proportion of women under 40 conceive using intrauterine insemination within 6 cycles?

Answer 3

50%

Question 4

What should men be informed about alcohol consumption?

Answer 4

Remaining within DoH recommended limits is unlikely to effect semen quality, however excessive alcohol intake is detrimental to semen quality

Question 5

What should women be informed about alcohol consumption?

Answer 5

Drink no more than 1/2 units once or twice a week and avoid intoxication

Question 6

Does smoking affect fertility in men?

Answer 6

Yes

Question 7

Does passive smoking affect fertility in women?

Answer 7

Yes

Question 8

Does caffeine affect fertility?

Answer 8

No

Question 9

How does a BMI above 30 affect fertility?

Answer 9

Women BMI>30 take longer to conceive as they may not ovulate

Men BMI>30 are likely to have reduced fertility

Question 10

What advice is given to women of BMI<19?

Answer 10

Increasing weight is will increase likelihood of conception

Question 11

Define infertility

Answer 11

A couple of reproductive age who has not conceived after 1 year of regular unprotected vaginal sexual intercourse

Question 12

What are the seven WHO reference values for semen analysis?

Answer 12

Semen volume: 1.5ml or more
pH: 7.2 or more
sperm concentration: 15 million per ml or more
total sperm number 39 million or more
total motility: 40% or more motile or 32% or more with progressive motility
Vitality: 58% or more
sperm morphology: 4% or more

Question 13

When should a repeat semen analysis take place following an abnormal result?

Answer 13

3 months after initial analysis to allow for the cycle of spermatozoa formation

Question 14

What are the three measures used to predict the ovarian response to gonadotrophin stimulation in IVF?

Answer 14

Total antral follicle count less than 4 indicates low response and higher than 16 indicates a high response
Anti-Mullerian hormone less than 5.4 pmol/l indicates low response and higher than 25 pmol/l indicates high response
FSH greater the 8.9 IU/l indicates low response and less than 4 IU/l indicate high response

Question 15

How is ovulation confirmed?

Answer 15

A blood test to measure serum progesterone in the mid-luteal phase (21-28 days)

Question 16

What are the four first line investigations for infertility?

Answer 16

Ovulation
Ovarian reserve
Tubes and transport
Sperm

Question 17

What are the four main reasons why fertility is reducing in the general population in the last 100 years?

Answer 17

Age
Obesity
STI
Sperm reduction due to processed foods and oestrogen remaining in water

Question 18

How is PCOS diagnosed?

Answer 18

Irregular, infrequent periods
Androgen excess
Ultrasound scan showing more than 10 follicles

Question 19

What are the two medications that can be used for a woman with PCOS to promote ovulation?

Answer 19

Metformin

Clomiphene