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Part 2 exam > Subfertility NICE CG156 - first line investigations > Flashcards

Subfertility NICE CG156 - first line investigations Flashcards

1
Q

What is the incidence of natural conception within the general population after trying to conceive for 1 year and the woman is under the age of 40?

A

80%

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2
Q

What is the cumulative natural conception rate within the general population after trying to conceive for 2 years and the woman is under the age of 40?

A

90%

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3
Q

What is the incidence of conception for women under 40 with 6 cycles of intrauterine insemination?

A

> 50%

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4
Q

What is the cumulative pregnancy rate for women under 40 with 12 cycles of intrauterine insemination?

A

75%

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5
Q

What type of sperm has higher pregnancy rates with Intrauterine insemination?

A

Fresh sperm has higher pregnancy rates than frozen-thawed sperm

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6
Q

Which artificial insemination procedure is associated with higher pregnancy rates?

A

Intrauterine insemination has higher pregnancy rates than intracervical insemination

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7
Q

How often should couples have sexual intercourse to try to conceive?

A

2-3 X per week

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8
Q

How much alcohol should couples trying to conceive drink?

A

Women – max 1-2 units 1-2 x per week

Men – max 3-4 units per day

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9
Q

What should couples trying to conceive be advised about smoking?

A

Women – advised smoking reduces fertility even passive smoking and refer to smoking cessation
Men – evidence that smoking reduces sperm quality but impact on male fertility is uncertain

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10
Q

What should couples trying to conceive be advised about BMI?

A

Women BMI >/=30 – will take longer to conceive
Women BMI >/= 30 and irregular periods/not ovulation – weight loss will improve chance of conception
Women BMI =19 and irregular periods – weight gain will improve chance of conception
Men BMI >/=30 – they are likely to have reduced fertility

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11
Q

Which patients are recommended to take 5mg folic acid?

A

Previous neural tube defect
Epilepsy
Diabetes

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12
Q

What lifestyle measures can be used to improve a couples chance of conception?

A

Weight control – increase if 19 or less, reduce if >/= 30
Regular intercourse 2-3 x per week
Alcohol intake control (1-2 units 1-2 x per week women)
Smoking cessation
No evidence that caffeine affects fertility

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13
Q

For women under the age of 36, when should the couple be referred for fertility investigations?

A

After 12 months of regular sexual intercourse

After 6 cycles of artificial insemination

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14
Q

13) When should couples have an early referral for fertility investigations?

A

Women 36 years or older
When there is a known cause of subfertility or possible pre-disposing factors
Cancer treatment is planned which would affect fertility

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15
Q

What are the normal parameters for semen analysis? volume?

A

> /= 1.5ml

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16
Q

What are the normal parameters for semen analysis? concentration?

A

> /= 15 million/ml

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17
Q

What are the normal parameters for semen analysis? ph?

A

> /= 7.2

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18
Q

What are the normal parameters for semen analysis? total sperm number?

A

> /= 39 milliion per ejaculate

19
Q

What are the normal parameters for semen analysis? motility?

A

> 40% motile or 32% progressively motile

20
Q

What are the normal parameters for semen analysis? vitality?

A

> /= 58% alive

21
Q

What are the normal parameters for semen analysis? morphology?

A

> /= 4% normal morphology

22
Q

What should you do if first semen analysis is abnormal

A

Repeat the semen analysis

In 3 months or as soon as possible if there are no sperm or very low sperm count

23
Q

What tests should not be carried out as initial fertility investigations?

A

Anti-sperm antibodies (relevance uncertain)
Post cervical cervical mucus
Ovarian volume or blood flow to predict IVF success
Inhibin B or oestradiol to predict IVF success
Routine prolactin and thyroid levels
Endometrial biopsy to assess luteal phase
Hysteroscopy as a first line investigation

24
Q

What is the first line predictor of success of natural conception and IVF?

A

Maternal age

25
Q

18) What is the annual fertility rate from natural conception for women aged 25-29, aged 30-34, aged 35-39, aged 40-44, age 45 and above?

A 
25-29              45-48% 
30-34              40-45% 
35-39              35-40% 
40-44              10-30% 
45+                  <10%
26
Q

Which measures can be used to predict a woman’s response to gonadotrophins simulation in IVF?

A

Total antral follicle count
Anti-mullerian hormone
FSH

27
Q

What predicted as a low response and a high response result for total antral follicle count?

A

Predicted low response = 4

Predicted high response >/= 16

28
Q

What predicted as a low response and a high response result for anti-mullerian hormone?

A

Predicted low response = 5.4 pmol/l

Predicted high response >/= 25pmol/l

29
Q

What predicted as a low response and a high response result for FSH?

A

Predicted low response = 8.9 IU/l

Predicted high response >/= 4 IU/l

30
Q

Who should prolactin be measured in?

A

Women with an ovulatory disorder
Galactorrhoea
Known pituitary tumour

31
Q

Which women should be offered HSG and which women should be offered lap dye test?

A

HSG – no known co-morbidities to assess tubal patency

Lap dye test – known or suspected endometriosis, previous ectopic pregnancy, PID

32
Q

Which tests are performed to investigate female factor infertility?

A

Blood tests – all women should have a mid-luteal phase progesterone, if ovulation disorder/known pituitary tumour/galactorrhoea - test prolactin, if menstrual irregularity – test LH and FSH, if signs of thyroid dysfunction test thyroid

Viral screen pre IVF – HIV, Hep B, Hep C

HSG if no comorbidities, lap dye test if suspected or known endometriosis, ectopic pregnancy, PID

33
Q

Which tests are performed to investigate male factor infertility?

A

Semen analysis

34
Q

What is the role of rubella testing and vaccination?

A

Test for rubella and those who are susceptible should be offered vaccine and should not fall pregnant within 1 month of the vaccine

35
Q

What factors reduce the risk of HIV transmission from a male HIV positive partner to female HIV negative partner to “negligible levels”?

A

Viral count <50 copies/ml
Compliant with HAART
No other infection present
Unprotected Intercourse just around time of ovulation

36
Q

Who do you offer sperm washing for?

A

Pre insemination when the man is HIV positive and is not compliant with HAART, or plasma viral count >50 copies/ml
Or the risk of HIV transmission is low but still unacceptable for the couple
Sperm washing lowers likelihood of pregnancy
Do not offer for patients with hepatitis B

37
Q

When might post-exposure prophylaxis for HIV be considered?

A

No evidence for its use in couples that meet low risk of transmission criteria

38
Q

What should be provided to couples where one of the partners is hepatitis B positive?

A

Hepatitis B vaccine to unaffected partner before fertility treatment

39
Q

What proportion of subfertility is unexplained?

A

25% (NICE) 30-40% (TOG16)

40
Q

What proportion of subfertility is male factor?

41
Q

What proportion of subfertility is tubal factor?

42
Q

What proportion of subfertility is caused by ovulatory disorders?

43
Q

What proportion of subfertility is caused by uterine and peritoneal disorders?

44
Q

What proportion of subfertility is caused by both female and male factors?

Part 2 exam (39 decks)

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