WH: Fertility

Question 1

what percentage of couples will conceive within 1 yrs of unprotected sex ?

Answer 1

85%
(1/7 struggle to concieve)

Question 2

when referral for infertility ?

Answer 2

Ix and referral should be considered after trying for 12 months (reduced to 6 months if woman >35 yrs)

Question 3

causes of infertility ? (6)

Answer 3

• sperm problems
• ovulation problems
• tubal problems
• uterine porblems
• unexplained
• mixed

Question 4

general fertility advice ?

Answer 4

• 400mg folic acid dialy
• healthy BMI
• stop smoking + drinking
• recue stress
• intercourse every 2-3 days
• avoid timed intercourse

Question 5

infertility Ix ? (4)

Answer 5

• BMI, chlamydia screening, semen analysis, female hormone testing

Question 6

what female hormone testing for infertility ?

Answer 6

serum LH + FSH, progesterone, AMH, TFT, prolactin

Question 7

annovulation Mx ? in PCOS ?

Answer 7

weight loss, clomifine, metformin
- ovarian drilling (PCOS)

Question 8

what type of drug is clomifene ? what used for ?

Answer 8

anti oestrogen: stops -ve feedback of oestrogen => increase GnRH => raise FSH + LH

Question 9

Mx of sperm problems ?

Answer 9

• surgical correction of obstruction
• intrauterine insemination
• donor insemination

Question 10

what does semen analysis look for ?

Answer 10

examine quality and quantity of sprem

Question 11

factors affecting semen quality/qunatitiy ?

Answer 11

hot baths, tight underwear, smoking, alcohol, raised BMI, caffein

Question 12

causes of male factor infertility ? (3 categories)

Answer 12

• pretesticular: pathology of AP of hypo, kallman syndrome, stress/chronic disease
• testicular: (damage): mumps, trauma, chemo, undescended testes, genetic (Kleinfelter)
• post testicular: obstruction, absence of vas deferens