Subfertility

Question 1

How is subfertility defined?

Answer 1

Failure to conceive after 1 year of regular unprotected sexual intercourse

Question 2

How many couples are affected by fertility issues in the UK?

Answer 2

1 in 7

Question 3

What is the difference between primary and secondary infertility?

Answer 3

Primary = never achieved pregnancy (after 1 year of trying)
Secondary = have become pregnant before, but now unable

Question 4

What levels of AMH, FSH and AFC may indicate subfertility?

Answer 4

Low AMH and AFC

High FSH

Question 5

At what age does a woman’s chance of conception start to decrease?

Answer 5

30

Question 6

What is the chance of conception each month for a woman aged 30-35?

Answer 6

15%

Question 7

What are the rough limits of time of the implantation window?

Answer 7

6-12 days after fertilisation

Question 8

What is the main treatment for male subfertility?

Answer 8

Bypass it using ICSI (intracytoplasmic sperm injection)

Question 9

What are risk factors for male subfertility?

Answer 9

Advancing paternal age
Life style factors 
Increased obesity
Co-morbidities
Use of anabolic steroids

Question 10

What are some causes of male factor subfertility?

Answer 10

Primary testicular dysfunction (due to trauma, infection, chemo etc)
Obstructive (congenital, infective)
Endocrine (hyperprolactinaemia, hypo hypo)
Drugs (smoking, alcohol, steroids)
Environment (heat, radiation, chemical)

Question 11

What is the most common cause of oligomenorrhoea?

Answer 11

Polycystic ovarian syndrome

Question 12

What are potential treatments for anovulation?

Answer 12

Exercise and weight loss

Metformin (effective in PCOS patients)

Question 13

How do fibroids affect fertility?

Answer 13

Decrease

By affecting implantation mainly

Question 14

What are causes of tubal disease?

Answer 14

Infection e.g. chlamydia
Previous surgery
Appendicitis/endometriosis

Question 15

What can we do to treat subfertility?

Answer 15

Ovulation induction
Intra-uterine insemination
IVF/ICSI
Sperm/egg donor
Cryopreservation of gametes/embryos

Question 16

Name some eligibility criteria for IVF?

Answer 16

age 23-39
BMI 19-30
both non smokers 
both not parents already
duration of subfertility 3 years

Question 17

What is the difference between IVF and ICSI?

Answer 17

IVF uses up to 100,000 sperm whereas ICSI uses a single sperm that is injected into the egg

Question 18

Is in-uterine insemination recommended in unexplained subfertility?

Answer 18

No