Subfertility + Infertility

Question 1

What is subfertility?

Answer 1

1 year of regular unprotected sex without conception
1/7 couples affected
Investigate those who do not conceive within 2 years
Primary: woman has never conceived
Secondary: woman has previously conceived

Question 2

Premature ovarian failure

Answer 2

Low/ normal oestradiol despite high LH + FSH

Question 3

PCOS

Aka Stein-Leventhal

Answer 3

Hypersecretion insulin -> GNRH -> incr LH -> incr ovarian androgen release -> less SHBG produced by liver
Rx: weight loss, clomiphene (incr FSH prod -> induces ovulation)

Question 4

Risks of PCOS

Answer 4

More susceptible to:
DM
Endometrial cancer
Dyslipidaemia

Question 5

Hypogonadotrophic hypogonadism

Answer 5

Failure of anterior pituitary to secrete LH + FSH = no ovulation
Secondary hypogonadism as gonads may have normal function
Hypo-oestrogenic sx

Question 6

Secondary Amenorrhoea

Answer 6

Absence of menses for 6 months in prev menstruating woman
Gonadal failure: premature ovarian failure
Pituitary dysfunction: pit tumour
Psych causes: stress, travel, weight changes can reduce GNRH
Endocrine dysfunction: hypothyroidism
Dysfunctional oestrogen metabolism: anorexia nervosa

Question 7

Prolactinoma

Answer 7

One of the commonest pituitary tumours
Excess prolactin inhibits gonadotropin release
Ix: MRI
Rx: dopamine agonists= bromocriptine

Question 8

Hypothyroidism

Answer 8

Screen for all woman with irreg menses
Low T4 reduces negative feedback= elevated prolactin + TSH
Inhibits gonadotrophin release

Question 9

Anorexia nervosa

Answer 9

Less adipose tissue
Where androgens are usually converted to oestrogens
Lower circulating levels of active oestradiol

Question 10

Turners syndrome

Answer 10

45 X0 1/2500
Ovaries don’t respond to gonadotrophin hormones
Almost universal infertility
Primary amenorrhoea + high FSH = karyotype to rule out Turners

Question 11

Mullerian Agenesis

Aka Mayer-Rokitansky-Kuster-Hauser syndrome

Answer 11

46 XX 1/4500
Embryonic mullein ducts fail to develop
Congenital absence of uterus, cervix, upper 2/3 vagina
Normal ext genitalia, secondary sexual characteristics (ovaries intact)
Psych support and surgery for neovagina to allow intercourse

Question 12

Lap and dye

Answer 12

Gold standard for tubal patency
Laparotomy = direct view, under general
Methylene blue injected into uterus via cervix
Patent =blue dye leaks from fimbrial ends of tubes
Hysteroscopy oft performed at same time

Question 13

Hysterosalpingogram

Answer 13

Radio-opaque fluid into uterine cavity via cervix
X-Rays taken
Normal :radio opaque fluid leak from ends of tube
Normal: 97% correct
Abnormal: 34% correct -> lap and dye req to confirm
Avoids risk of surgery and anaesthetic, outpatient procedure

Question 14

Salpingoscopy

Answer 14

Salpingoscope inserted into ampullary portion of Fallopian tube at laparoscopy to investigate fine intramural adhesions

Question 15

Asthenospermia

Answer 15

Poorly motile sperm

Question 16

Azoospermia

Answer 16

Complete absence of sperm - testicular failure

Question 17

Oligospermia

Answer 17

Reduced sperm count of normal appearance

Question 18

Teratospermia

Answer 18

Morphologically defective

Question 19

Leucospermia

Answer 19

Infection

Question 20

Sperm analysis

Answer 20

Two analyses needed 3 months apart 
(3 months for spermatogenesis) 
Production
Function
Delivery
Tested

Question 21

Normal values in semen analysis

Answer 21

Vol: >2ml
pH: 7-8
Conc: >20 x 10^6/ml
Motility: >50% forward, >25% rapid linear progress
Morphology: >15% normal
Alive: >50%
Negative for antisperm antibodies 
WCC: