Infertility

Question 1

Define infertility

Answer 1

The inability to conceive after 12 months of regular intercourse without use of contraception

Question 2

What are the chances of conception?

Answer 2

80% of the general population will conceive in 1 year if:

• Woman is under 40
• No use of contraception
• 90% within the second year

Question 3

What are the 4 points of the infertility consultation?

Answer 3

Are eggs available?
Are sperm available?
Can they meet?
Can the embryo implant?

Question 4

What happens in a female examination for infertility?

Answer 4

Weight
Height
BMI
Fat and hair distribution
Galactorrhea
Abdominal examination
Pelvic examination

Question 5

What are the causes of hirsutism?

Answer 5

Nonclassical congenital adrenal hyperplasia
PCOS
Cushings
Acromegaly
Androgen secreting tumour (ovarian or adrenal)
Ovarian hyperthecosis

Question 6

What are the signs of hirsutism?

Answer 6

Deep voice
Hair growth
Acanthosis nigricans

Question 7

What is done on a pelvic examination?

Answer 7

Masses
Distortion
Tenderness
Vaginal septum
Cervical abnormalities

Question 8

What are the baseline investigations for fertility?

Answer 8

Female
-Rubella immunity
-Chlamydia
-TSH
-Regular periods = mid luteal progesterone
-Irregular periods = day 1-5 FSG, LH, PRL, TSH and testosterone
Male partner semen analysis

Question 9

What are the investigations at the fertility clinic?

Answer 9

Pelvic USS
Physical examination
Ovulation test
Semen analysis
Tubal patency test

Question 10

What is done in a male history for infertility?

Answer 10

Testicular descent
Change in shaving frequency
Loss of body hair 
Mumps
STD
Varicocele repair
Vasectomy
Previous fertility
Drugs/environmental
Sexual history
Chronic medical illness

Question 11

What is done in a male examination for infertility?

Answer 11

Weight
Height
BMI
Fat and hair distribution
Abdominal an inguinal examination
Genital examination (epididymis, testes, vas defrens and varicocele)

Question 12

What can cause epididymitis?

Answer 12

STD’s

Chlamydia and gonorrhoea

Question 13

What happens in a variocele?

Answer 13

Dilation of the pampiniform plexus

Presumptive infertility, abnormal semen

Question 14

What can cause problems with the vas defrens?

Answer 14

CF = mutations and bilateral absence of the vas deferens (CBAVD)

Question 15

What are the low lab results for male semen?

Answer 15

Volume = 1.5ml
Conc = 15mil/ml
Total number = 39mil
Progressive motility = 32%
Total motility = 40%
Morphologically normal = 4%

Question 16

When to refer for investigation for infertility?

Answer 16

After 1 year of trying

Question 17

What is an ovulatory disorder?

Answer 17

Group 1 = hypothalamic pituitary failure
Group 2 = HPO dysfunction
Group 3 = Ovarian failure

Question 18

What causes group1 ovulation disorders?

Answer 18

Low body weight
Stress
Tumours affecting the hypothalamus
Amenorrhoea 
Idiopathic

Question 19

What is polycystic ovarian syndrome?

Answer 19

1. Androgen excess
   - Clinical (hirsutism)
   - Biochemical (testosterone)
2. Infrequent periods
   - Anovulation
3. Polycystic ovaries
   - USS

Question 20

What is done for ovulation induction?

Answer 20

Clomiphene (blocks oestrogen receptors = increased secretion of FSH)

Gonadotrophins = FSH injection

GnRH

Question 21

What are the investigations for Azoospermia?

Answer 21

History
Examination
FSH, LH, testosterone, karyotype and RRL
CF screen

Question 22

What is hydrosalpinges?

Answer 22

Salpingectomy surgery on this should be done by laparoscopy before IVF = better chances of a live birth

Question 23

What happens in unexplained infertility?

Answer 23

Age
Previous pregnancy
Duration of infertility
Dont offer stimulation agents
2 years of normal method must be done before IVF is offered