3 - Fertility

Question 1

Subfertility

Answer 1

Failing to conceive in one year of regular, unprotected, sexual intercourse

Question 2

Infertility

Answer 2

failure to become pregnant after 12 months and more of regular unprotected sexual intercourse

Question 3

Primary Infertility

Answer 3

being unable to ever bear a child. Includes miscarriages, ectopics, abortions and stillborns.

Question 4

Secondary Infertility

Answer 4

being unable to bear a child following either a previous pregnancy or a previous ability to carry a pregnancy to a live birth

Question 5

Hypopituitary Failure

Answer 5

Anorexia Nervosa

Question 6

Hypopituitary Dysfunction

Answer 6

PCOS

Hyperprolactinaemia

Question 7

Ovarian failure

Answer 7

If under 40 y/o - premature

Question 8

Women in UK with PCOS

Answer 8

33% with polycystic ovaries

33% of that 33% with PCOS

Question 9

Symptoms of PCOS

Answer 9

menstrual disturbance
Acne
Male pattern hair loss
Central obesity

Question 10

PCOS LH, FSH and Testosterone levels

Answer 10

Raised LH
Normal FSH
Raised testosterone

Question 11

Rotterdam Criteria for PCOS

Answer 11

2 of 3
Clinical hyperandrogenaemia
Oligomenorrhoea (6 to 9 in a year)
Polycystic Ovaries on Ultrasound

Question 12

Pelvic inflammatory disease symptoms

Answer 12

May be asymptomatic

o Acute: pelvic pain, deep dyspareunia, malaise, fever

Question 13

Endometriosis symptoms

Answer 13

Pain, dysmenorrhoea, menorrhagia, dyspareunia

Question 14

Treatment of endrometriosis

Answer 14

NSAIDs for pain

Surgery

Question 15

Fibroids

Answer 15

o Benign tumours of the smooth muscle of the myometrium

Question 16

Fibroids symptoms

Answer 16

heavy, regular periods

Question 17

Male causes of infertility

Answer 17

Testicular
Ejaculatory
Hypogonadism

Question 18

Drugs linked to infertility - women

Answer 18

long terms NSAID use, chemotherapy, neuroleptics, spironolactone, depo-provera.

Question 19

Drugs linked to infertility - male

Answer 19

sulfasalazine, anabolic steroids, chemotherapy, Chinese herbs for improving sperm count and motility.

Question 20

Management of Hypopituitary failure

Answer 20

increase weight, decrease exercise.

Consider pulsatile GnRH or Gn with LH activity to induce ovulation.

Question 21

Management of PCOS

Answer 21

weight loss
Clomiphene or metformin
Surgery - laparoscopic ovarian drilling

Question 22

Management of Hyperprolacinaemia

Answer 22

Bromocriptine

Question 23

When to offer IVF in unexplained infertility

Answer 23

2 years

Question 24

What is Intrauterine Insemination

Answer 24

Sperm is separated in lab, removal of slower speed sperm, before partner is inseminated

Question 25

Who do you offer IUI to

Answer 25

People who are unable to have vaginal intercourse (disability). Requiring specific consideration (eg sperm wash in HIV pos men) Same-sex relationships

Question 26

How many cycles of IUI before offer IVF?

Answer 26

12

Question 27

What is in vitro fertilisation?

Answer 27

Fertilisation of an egg (or eggs) outside the body

Question 28

Who do you offer IVF to

Answer 28

o Women under 40 who have not conceived after 2 years of unprotected intercourse or 12 cycles of artificial insemination (6 IUI). o Offer 3 full cycles (cycle being 1 ovarian stimulation and transfer of resultant fresh/frozen embryos).

Question 29

Ovarian hyperstimulation syndrome

Answer 29

Consequence of drugs used to stimulate ovarian function e.g gonadotrophin or clomifene

Question 30

What is Intracytoplasmic Sperm Injection

Answer 30

Embryologist selects a single sperm to be injected directly into an egg, instead of fertilisation taking place in a dish where many sperm are placed near an egg.

Question 31

When is ICSI indicated

Answer 31

o Severe deficits in semen quality o Obstructive azoospermia o Non-obstructive azoospermia o Couple in whom previous IVF treatment cycle has resulted in failed or very poor fertilisation