T2 L8: Causes of subfertility

Question 1

What is the most common site of an ectopic pregnancy?

Answer 1

In the ampulla of the fallopian tubes because that’s where the sperm reaches the egg during fertilisation

Question 2

What are the causes of infertility?

Answer 2

Female factor (30%)
Male factor (30%)
Combined (10%)
Unexplained (25%)
Other causes (5%)

Question 3

What are some female factors to infertility?

Answer 3

• Ovulation disorders: PCOS (80%), premature ovarian insufficiency, hypopituitarism, damage to ovaries
• Tubal blockage: Pelvic inflammatory disease, endometriosis, ectopic pregnancy
• Age-related: limited ovarian reserve
• Uterine problems: synechiae, polyp, fibroid

Question 4

What are the most common causes of pelvic inflammatory disease?

Answer 4

Chlamydia or Gonnorhoea infection

Question 5

What is the basic work up for a couple with infertility?

Answer 5

• History and examination of both partners
• FSH, LH, oestradiol, and TFT at day 2-3 of period
• Mid-luteal progesterone (7 days before period)
• Chlamydia and rubella swab
• HSG scan
• Pelvic ultrasound

Question 6

What is a HSG scan?

Answer 6

A specialised x-ray for the uterus and fallopian tubes

Question 7

What is the effect of AMH (anti-Mullerian hormone) have on fertility?

Answer 7

A higher AMH level predicts a better response

The levels decrease with age

Question 8

What anti-Mullerian hormone (AMH)?

Answer 8

It’s produced by the Granulosa cells and is produced in high concentrations in pre-natal and small antral stages

Question 9

What does an ovarian reserve assessment measure?

Answer 9

The number and quality of eggs

Question 10

By what age are most of the good eggs released?

Answer 10

By 35

Question 11

What is a HSG scan?

Answer 11

It tests tubal patency

Question 12

What is a HyCoSy scan?

Answer 12

An ultrasound and dye tests used to look for blockages

Question 13

What is a laparoscopy?

Answer 13

Keyhole surgery

Question 14

What is the normal semen analysis outcome?

Answer 14

Count: 1.5x10^6
Motility: 40%
Abnormal forms: 96%
Volume: 2-6ml

Question 15

What is sperm motlilty?

Answer 15

The percentage of sperm moving

Question 16

What are the new NICE guidelines for unexplained fertility treatment?

Answer 16

• Don’t offer intra-uterine insemination
• Don’t offer oral ovulation stimulation
• Offer IVF to women who have not conceived after 2 yrs (3 courses to <40. 1 course to >40)

Question 17

Which drug treatments are used to help with infertility?

Answer 17

Clomiphine, Letrozole, and FSH injections

Question 18

What effect does taking Metformin or Clomiphene have on fertility with PCOS?

Answer 18

It increases fertility

Clomiphene is superior but doesn’t increase chance of live birth

Question 19

What is a Buserelin injection?

Answer 19

A hormone used to stop the release of an egg so that the eggs can be collected for IVF

Question 20

When is Intra-cytoplasmic sperm injection (ICSI) used?

Answer 20

When the sperm quality is low