Investigation and treatment of infertility

Question 1

What sort of details are important for taking a history for a couple with fertility problems?

Answer 1

How long together
How long have you been trying to conceive
Pregnancies together and outcomes
Pregnancies with previous partners
Smoking and alcohol
Coital frequency, timing and problems

Question 2

What sort of details are important for taking a history for a female with fertility problems?

Answer 2

Cycle
Weight/change in weight
Drugs
Risk of tubal disease (STI, ectopic, surgery)

Question 3

What sort of details are important for taking a history for a male with fertility problems?

Answer 3

Occupation
Testicular maldescent
Trauma
Infections (STI, mumps orchiditis)
Surery
Drugs (therapeutic, recreational)

Question 4

What are the basic investigations used to investigate fertility problems

Answer 4

Ovulation
Semen fluid analysis
Pelis anatomy and tubal patency
Ovarian reserve

Question 5

How can pelvic anatomy and fallopian tube patency be assessed?

Answer 5

Laparoscopy and dye = gold standard in tubal patency evaluation
Hysterosalpinogram (HSG)
Hystero contrast sonogram

Question 6

What is AMH

Answer 6

Anti-mullerian hormone

Produced by granulosa cells, from the pre-antral and antral follicles
Can be measure anytime in the cycle and intercycle variability is low
Can be accuratly measured in women receiving hormonal contraception

Question 7

What are the different types of anovulation

Answer 7

Group 1:
Hypothalamic pituitary failure (hypothalamic amenorrhoea or hypogonadotrophic hypogonadism)

Group 2:
Hypothalamic-pituitary-ovarian dysfunction (usually PCOS)

Group 3:
Ovarian failure

Question 8

What is azoospermia?

Answer 8

Azoospermia is the medical condition of a man whose semen contains no sperm

Question 9

What causes obstructive azoospermia?

Answer 9

Normal sized testes and FSH level

Post infection, post vesectomy, congenetial absence of vas deferens

Question 10

What causes non-obstructive azoospermia?

Answer 10

Small testes, raised FSH

testicular failure

Question 11

Clinically, how can you tell the difference between obstructive and non-obstrucive azoospermia?

Answer 11

Obstructive: normal sized testes and normal FSH

Non-obstructive: small testes and raised FSH

Question 12

What is ICSI

Answer 12

Intracytoplasmic sperm injection

Question 13

How can sperm be retrieved for ICSI?

Answer 13

PESA = percutaneous epidydymal sperm aspiration
TESE = testicular sperm extraction