B8-001 Infertility

Question 1

women over […] qualify for immediate fertility evaluation

Answer 1

40

Question 2

[…] is most predictive of fertility

Answer 2

maternal age

Question 3

the egg is typically fertilized in the […] of the fallopian tube

Answer 3

ampulla

Question 4

when is the embryo implanted in IVF?

Answer 4

day 6-7

(when it would physiologically be in the uterus preparing for implantation)

Question 5

indications for ovarian reserve testing [5]

Answer 5

greater than 35 yo
tobacco use
prior ovarian surgery
prior gonadotoxin exposure
primary relative with POI

Question 6

test most indicated for uterine/fallopian tube abnormalities

Answer 6

hysterosalpingogram (HSG)

Question 7

pathogens causing tubal infertility

Answer 7

chlamydia
gonorrhea
TB (worldwide)

Question 8

critical window for male abstinence allowing for proper evaluation of sperm

Answer 8

2-5 days between ejaculates

Question 9

if primary semen analysis is abnormal, what is the recommendation?

Answer 9

lifestyle changes

Question 10

if repeat semen analysis is abnormal, what is the recommendation?

Answer 10

labs looking at testosterone, prolactin, estrogen, LH, FSH

urology consult for anatomical issues

Question 11

low sperm concentration/count

Answer 11

oligospermia

Question 12

low sperm motility

Answer 12

asthenospermia

Question 13

low/abnormal sperm morphology

Answer 13

teratospermia

Question 14

a basic pH of the semen can indicate

Answer 14

GU infection

Question 15

a acidic pH of the semen can indicate

Answer 15

obstructive azoospermia or blocked seminal vesicles

Question 16

normal volume for semen analysis

Answer 16

> 1.5 mL

Question 17

normal pH for semen analysis

Answer 17

7.2-8.0

Question 18

normal concentration for semen analysis

Answer 18

greater than 15 million

(consider length of abstinence)

Question 19

normal motility for semen analysis

Answer 19

greater than 39%

(lower indicates membrane issue)

Question 20

normal total motile sperm for semen analysis

Answer 20

greater than 40 x 10^6

Question 21

normal vitality for semen analysis

Answer 21

greater than 75%

Question 22

normal morphology for semen analysis

Answer 22

greater or equal to 4%

Question 23

normal WBC for semen analysis

Answer 23

less than 1 million

(higher indicates chronic inflammation)

Question 24

treatment of male infertility with a sperm count greater than or equal to 10 million

Answer 24

intrauterine insemination

Question 25

treatment of male infertility with a sperm count less than 10 million

Answer 25

IVF or ICSI

Question 26

treatment of male infertility due to low motility

Answer 26

NECA via IUI | NECA stimulates sperm motility

Question 27

treatment of male infertility due to anti-sperm antibodies

Answer 27

chymotrypsin/galactose via IUI

Question 28

treatment of male infertility due to poor liquefaction

Answer 28

chymotrypsin/chymotrypsin inhibitor via IUI

Question 29

most common reversible cause of male infertility

Answer 29

varicocele (swelling of veins that drain the testes)

Question 30

pathogens causing epididymitis/orchitis [2]

Answer 30

gonorrhea HIV

Question 31

causes of retrograde ejaculation

Answer 31

diabetes spinal injuries medications GU surgery

Question 32

the presence of fructose indicates a [...] origin of azoospermia

Answer 32

testicular

Question 33

absence of fructose and sperm in semen analysis indicates

Answer 33

absence of seminal vesicles, vas defrens, or obstruction

Question 34

chromosomal causes of male infertility [4]

Answer 34

klinefelters cystic fibrosis kallmann's syndrome kartagener's syndrome

Question 35

aromatase inhibitor

Answer 35

letrozole

Question 36

SERM

Answer 36

clomiphene citrate

Question 37

approved for estrogen + breast cancer

Answer 37

letrozole

Question 38

estrogen agonist on ovaries antagonist on uterus

Answer 38

clomiphene citrate

Question 39

adverse effects of clomiphene citrate [3]

Answer 39

hot flashes mood swings increased risk of multiples

Question 40

treatment for male factor or unexplained fertility

Answer 40

IUI

Question 41

direct testing of embryos for single, inherited genetic disease

Answer 41

preimplantation genetic testing for monogenic disease (PGT-M)

Question 42

direct testing of IVF embryos for numeric chromosome abnormalities used in women of AMA and recurrent pregnancy loss

Answer 42

preimplantation genetic testing for aneuploidy (PGT-A)

Question 43

asthenospermia means...

Answer 43

low motility, less than 39%

Question 44

oligospermia means...

Answer 44

low concentration less than 15,000/ml

Question 45

prolonged abstinence will negatively affect [...] of sperm in semen analysis

Answer 45

motility

Question 46

[...] is secreted from the seminal vesicles, and will reveal if lack of sperm is at the level of the seminal vesicles

Answer 46

fructose

Question 47

first line therapy for fertility therapy in women with PCOS

Answer 47

aromatase inhibitor (letrozole)

Question 48

[...] are effective in ovulation induction in PCOS but are not first line as the risk of multiple gestation pregnancy is significantly higher

Answer 48

gonadotropins

Question 49

viable option for PCOS related infertility that has not responded to pharmacotherapy

Answer 49

ovarian drilling

Question 50

most common presentation for women with hydrosalpinx

Answer 50

infertility

Question 51

best management for infertility in a patient with Turner's syndrome

Answer 51

donor oocytes after cardiac clearance (turner's patients have increased risk of aortic rupture that doubles with pregnancy due to increased blood volume)

Question 52

first line therapy in women with WHO 1 amenorrhea

Answer 52

behavioral modification

Question 53

resumption of menses may take up to [...] in women with WHO 1 amenorrhea following behavioral modification

Answer 53

18 months