Subfertility management_Flashcards

Question 1

What investigations are recommended for subfertility?

Answer 1

Investigations for subfertility include STI screening, assessment of pelvic anatomy, blood hormone profile, antral follicle count, tubal assessment, and semen analysis.

Question 2

What STI screenings are recommended for men and women considering assisted reproductive technology (ART)?

Answer 2

Chlamydia screening in men and women, and HIV, hepatitis B, and hepatitis C screening if assisted reproductive technology (ART) is being considered.

Question 3

How is the assessment of pelvic anatomy usually conducted in subfertility investigations?

Answer 3

Assessment of pelvic anatomy is usually conducted using transvaginal ultrasound (TVUSS) or hysterosalpingography (HSG) with X-ray or ultrasound, or laparoscopy and dye.

Question 4

What blood hormone profile tests are useful in subfertility investigations?

Answer 4

Early follicular phase FSH, LH, and oestradiol levels (day 2-3), Anti-Mullerian hormone (AMH) for assessing ovarian reserve, and mid-luteal progesterone to confirm ovulation.

Question 5

What is the significance of Anti-Mullerian hormone (AMH) in assessing ovarian reserve?

Answer 5

Anti-Mullerian hormone (AMH) is helpful for assessing ovarian reserve as it is independent of the menstrual cycle and produced by granulosa cells, making it the most successful biomarker of ovarian reserve.

Question 6

What is the purpose of measuring mid-luteal progesterone in subfertility investigations?

Answer 6

Measuring mid-luteal progesterone confirms ovulation in subfertility investigations.

Question 7

What additional tests may be useful if a patient has an irregular menstrual cycle?

Answer 7

If a patient has an irregular menstrual cycle, TFTs, prolactin, and testosterone may also be useful in subfertility investigations.

Question 8

What is the importance of antral follicle count in subfertility investigations?

Answer 8

Antral follicle count is an important parameter of ovarian reserve. A count of < 4 indicates a poor response, while a count of 16+ indicates a good response.

Question 9

What methods are used for tubal assessment in subfertility investigations?

Answer 9

Tubal assessment methods include hysterosalpingo contrast sonography (HyCoSy) and hysterosalpingography (HSG).

Question 10

When is tubal patency assessment usually performed?

Answer 10

Tubal patency assessment is usually performed if there are risk factors for tubal damage such as PID, endometriosis, or ectopic pregnancy.

Question 11

How is semen analysis conducted in subfertility investigations?

Answer 11

Semen analysis usually consists of 2 tests done 3 months apart.

Question 12

What conservative management options are recommended for subfertility?

Answer 12

Conservative management options for subfertility include regular intercourse every 2-3 days, reducing smoking, reducing alcohol intake, managing obesity and low body weight, and addressing drug use, stress management, and occupational risks.

Question 13

What lifestyle modifications can improve fertility in subfertility patients?

Answer 13

Lifestyle modifications that can improve fertility include regular intercourse, reducing smoking and alcohol intake, managing obesity and low body weight, and addressing drug use, stress management, and occupational risks.

Question 14

What is the role of ovulation induction in the medical management of subfertility?

Answer 14

Ovulation induction with clomiphene or FSH is recommended for anovulation (PCOS, idiopathic) in the medical management of subfertility.

Question 15

When is intrauterine insemination recommended in subfertility management?

Answer 15

Intrauterine insemination is recommended for unexplained subfertility, anovulation unresponsive to ovulation induction, mild male factor subfertility, and minimal to mild endometriosis.

Question 16

When is donor insemination recommended in subfertility management?

Answer 16

Donor insemination is recommended for the presence of azoospermia, single women, and same-sex couples.

Question 17

When is in-vitro fertilisation (IVF) recommended in subfertility management?

Answer 17

In-vitro fertilisation (IVF) is recommended for patients with tubal pathology and those who underwent other treatments with no success.

Question 18

When is donor egg IVF recommended in subfertility management?

Answer 18

Donor egg IVF is recommended for women whose egg quality is poor or who have had previous surgery or chemotherapy that adversely affected ovarian function.

Question 19

What surgical management options are available for subfertility?

Answer 19

Surgical management options for subfertility include operative laparoscopy to treat disease and restore anatomy, myomectomy, tubal surgery, and laparoscopic ovarian drilling.

Question 20

What are the common conditions treated with operative laparoscopy in subfertility management?

Answer 20

Common conditions treated with operative laparoscopy in subfertility management include adhesions, endometriosis, and ovarian cysts.

Question 21

What is the role of myomectomy in subfertility management?

Answer 21

Myomectomy, which can be done via hysteroscopy, laparoscopy, laparotomy, or fibroid embolisation, is used to treat fibroid uterus in subfertility management.

Question 22

When is tubal surgery considered in subfertility management?

Answer 22

Tubal surgery is considered in subfertility management for blocked fallopian tubes that are amenable to repair.

Question 23

What is the purpose of laparoscopic ovarian drilling in subfertility management?

Answer 23

Laparoscopic ovarian drilling is used for PCOS that is unresponsive to medical treatment in subfertility management.

Question 24

What are the key risk factors for subfertility?

Answer 24

Key risk factors for subfertility include advanced maternal age, smoking and alcohol use, obesity, irregular periods, STIs, and low BMI.

Question 25

How should the diagnosis of subfertility be explained to patients?

Answer 25

Explain that 80% of couples will fall pregnant if trying regularly for 12 months, and of those that don’t, 50% will conceive in the 2nd year of trying, giving a cumulative pregnancy rate of 90%.

Question 26

What is the recommended frequency of unprotected sex for couples trying to conceive?

Answer 26

Couples trying to conceive should have regular unprotected sex at least every other day.

Question 27

What are the common management options for subfertility based on the likely cause?

Answer 27

Common management options for subfertility include conservative management, ovulation induction, intrauterine insemination, donor insemination, in-vitro fertilisation, donor egg IVF, and surgical management depending on the likely cause of subfertility.