Infertility

Question 1

Hormonal trigger of ovulation

Answer 1

LH

Question 2

During normal period, when does progesterone peak?

Answer 2

Following ovulation

Question 3

Test to confirm ovulation (for couples trying to conceive)

Answer 3

Mid-luteal serum progesterone (>30 nmol/L)

Question 4

Luteal phase =

Answer 4

Lasts 14 days following ovulation

Question 5

Commonest cause of ovulatory problems =

Answer 5

Polycystic Ovarian Syndrome (PCOS)

Question 6

Diagnostic criteria for PCOS

Answer 6

2 of:
1. Oligo/amenorrhoea
2. Polycystic ovaries on scan
3. Clinical/biochemical signs of hyperandrogenism (acne/hirsutism)

Question 7

Treatment to induce ovulation

Answer 7

1. Clomifene citrate/Tamoxifen
2. Gonadotrophin injections (recombinant FSH)
3. Laparoscopic ovarian diathermy (electrical currents to burn ovary)

Question 8

Investigation for tubal patency

Answer 8

Hysterosalpingogram

(or diagnostic laparoscopy and hydrotubation (HTB))

Question 9

When is hysteroscopy used?

Answer 9

Only when endometrial pathology is suspected

Question 10

What if clomifene doesn’t lead to ovulation?

Answer 10

Take adjuvant metformin

-improves insulin resistance
-reduces androgen production
-improves sensitivity to clomifene

Question 11

Risks of gonadotrophin injections

Answer 11

Multiple pregnancy, overstimulation

Question 12

Risks of laparoscopic ovarian diathermy

Answer 12

Ovarian destruction

(however, doesn’t cause multiple pregnancy)

Question 13

What is this?

Answer 13

Hydrosalpinx - fluid build-up in fallopian tube

(reduces IVF success by 50%)