Subfertility/infertility

Question 1

How many couples have infertility issues?

Answer 1

1 in 7

Question 2

What % of couples are pregnant within one year and 2 years of trying?

Answer 2

1 year - 80%

2 years - 90%

Question 3

Infertility

Answer 3

inability to conceive after 12 months of regular intercourse without use of contraception

Question 4

4 questions you ask yourself with infertility?

Answer 4

are eggs available?
are sperm available?
can they meet?
can embryo implant?

Question 5

Questions in female history

Answer 5

psychological - duration of infertility - previous contraception - fertility in previous issues - previous pregnancies and complications - menstrual history - medical and surgical history - sexual history - previous investigations

Question 6

Female examination

Answer 6

abdomen - pelvic - BMI - height - weight - fat and hair distribution - galactorrhoea

Question 7

What BMI is considered for IVF referral?

Answer 7

under 30

Question 8

What can galactorrhoea be a sign of?

Answer 8

prolactinoma

Question 9

Cause of mild hirsutism

Answer 9

PCOS

Question 10

Causes of severe hirsutism

Answer 10

late onset adrenal hyperplasia

androgen secreting tumour eg adrenal or ovarian

Question 11

Biochemical measurements used in androgen excess

Answer 11

DHA 
DHAS
SHBG
17-OH progesterone
testosterone
androsterodione

Question 12

Clinical measurement of androgen excess and what it looks at

Answer 12

Ferriman Gallwey score

hair on upper lip, face, chest, abdomen

Question 13

Name one sign of andogen excess

Answer 13

acanthosis nigricans

Question 14

findings on female pelvic examination of note

Answer 14

tenderness
masses
pelvic distortion
fixed retroversion

Question 15

3 symptoms of fibroids

Answer 15

pressure symptoms
period problems
infertility

Question 16

Male history

Answer 16

sexual history - previous investigations and treatment - previous fertility - medical and surgical history - occupational history

Question 17

Male examination

Answer 17

weight - height - BMI - fat and hair distribution - abdominal and inguinal exam - genital exam

Question 18

findings/what to look for in genital exam of males

Answer 18

testis 
varicocoele 
penis 
epididymis
vas deferens

Question 19

Causes of epididymitis

Answer 19

STD - chlamydia trachomatis, gonorrhoea, NSTD

Question 20

What should you think of if small testicular size?

Answer 20

Klinefelters syndrome - 47 XXY

Question 21

Importance of vas deferens in infertility

Answer 21

CF mutations and congenital bilateral absence of vas deferens

Question 22

Hypospadias

Answer 22

urethral opening on underside of penis

Question 23

varicocoele

Answer 23

abnormal torsion and dilation of veins

Question 24

How to assess man’s sperm

Answer 24

computerised semen analysis

Question 25

How to determine if eggs are available?

Answer 25

hormonal levels

Question 26

Usually refer if no pregnancy in 1 year, exceptions to this rule are...

Answer 26

``` period irregularity PMH testicular problems abnormal testis age HIV/Hep B anxiety ```

Question 27

female Age for referral - after trying for how long?

Answer 27

under 35 - 1 year 35-45 - 6 months rarely refer after 45

Question 28

Baseline female investigations

Answer 28

rubella immunity chlamydia TSH mid luteal progesterone if regular periods 1-5 day FSH, LH, PRL, TSH, testosterone if irregular

Question 29

Male baseline investigations

Answer 29

semen analysis

Question 30

Investigations

Answer 30

Pelvic USS semen analysis repeat tubal patency test - HyCoSy

Question 31

3 parts of PCOS

Answer 31

androgen excess - hirsutism and testosterone USS polycystic ovaries infrequent periods - anovulation

Question 32

How can ovulation be achieved?

Answer 32

clomifene, gonadotrophins, GnRH

Question 33

What type of medication is clomifene?

Answer 33

selective oestrogen receptor modulator

Question 34

Dose of clomifene

Answer 34

50mg-150mg day 2-6

Question 35

If there is amenorrhoea what is important to do if using clomifene?

Answer 35

prime with progestogen

Question 36

Monitoring of clomifene

Answer 36

follicle scan in 1st cycle

Question 37

side effects of clomifene

Answer 37

vasomotor and visual

Question 38

2 reasons for using gonadotrophins for ovulation

Answer 38

no ovulation with clomifene | ovulation but no pregnancy with clomifene

Question 39

What medication is used for gonadotrophin treatment?

Answer 39

FSH injection for 3-6 cycles

Question 40

Male factor infertility - what can be used?

Answer 40

``` ICSI donor insemination intra-uterine insemination IVF surgery eg reversal of vasectomy, surgical sperm retrieval ```

Question 41

3 testicular causes of azoospermia

Answer 41

normogonadotrophic hypogonadism hypergonadotrophic

Question 42

3 post-testicular causes of azoospermia

Answer 42

iatrogenic, congenital, infective

Question 43

Investigations for azoospermia

Answer 43

history and examination CF screen FSH,LH,PRL, testosterone, karyotype

Question 44

2 methods of surgical sperm retrieval

Answer 44

micro epididymal sperm aspiration | testicular sperm extraction

Question 45

Sexual problems solution

Answer 45

psychosexual counselling | artificial insemination - timed at home or Intra-uterine in clinic

Question 46

Describe IVF

Answer 46

1. eggs harvested from ovary 2. eggs fertilised in lab with sperm 3. embryos undergo cell division 4. Embryos transferred to the womb

Question 47

Describe ICSI

Answer 47

injection of mature eggs with single sperm incubate overnight transfer embryo at day 5

Question 48

cryopreservation

Answer 48

freezing eggs

Question 49

Changing society within fertility examples

Answer 49

obesity - lesbian couples - single women - post humous insemination - older women