Female Infertility

Question 1

What is infertility?

Answer 1

Failure to conceive after 2 years of regular unprotected sexual intercourse (UPSI)

Question 2

What is primary subfertility?

Answer 2

Never managed to conceive

Question 3

What is secondary subfertility?

Answer 3

Managed to conceive in the past but difficulty conceiving again

Question 4

What are the risk factors?

Answer 4

Smoking
Obesity
Occupational risks
Excessive alcohol consumption
Drug use

Question 5

What are the different causes?

Answer 5

Ovarian/ovulatory
Tubal
Pelvic uterine
Male infertility
No identifiable cause

Question 6

What is the most common type of ovarian cause?

Answer 6

Anovulation

Question 7

What is anovulation?

Answer 7

Failure of ovary to release over a period of least 45 days

Question 8

What is the WHO classification of ovarian problems?

Answer 8

Group I
Group II
Group III

Question 9

What is Group I?

Answer 9

Hypogonatrophic hypogonadism
= impaired secretions of gonadotropins

Question 10

What is seen in Group I?

Answer 10

Low levels of FSH + LH = low oestradiol levels

Question 11

What are the causes of Group I?

Answer 11

Prolactinomas (pituitary tumours)
Hypothyroidism
Drugs - antipsychotics, antidepressants, opioids + anti-hypertensives

Question 12

What is Group II?

Answer 12

Hypothalamic-pituitary-ovarian dysfunction

Question 13

What is seen in Group II?

Answer 13

Raised FSH/LH ratio

Question 14

What is the main problem seen in Group II?

Answer 14

Polycystic ovary syndrome (PCOS)

Question 15

What are the symptoms of PCOS?

Answer 15

Fewer or no periods
Hirsutism
Obesity
Acne
Infertility

Question 16

What is Group III?

Answer 16

Hypergonadotrophic hypogonadism
= impaired response to gonadotrophins

Question 17

What is seen in Group III?

Answer 17

High levels of FSH + LH

Question 18

What are the causes of Group III?

Answer 18

Chromosomal abnormalities
Premature ovarian failure
Surgery/trauma
Defects in hormone synthesis

Question 19

What are the causes of tubal problems?

Answer 19

Damage/blockage to fallopian tubes
= prevent sperm reaching ovum
Pelvic inflammatory disease (PID)

Question 20

What are the causes of pelvic problems?

Answer 20

Pelvic adhesions + endometriosis
Pelvic damage from chlamydia

Question 21

What are the causes of uterine problems?

Answer 21

Abnormalities = fibroids, polyps + adhesions
= affect sperm migration + embryo implantation

Question 22

What is the treatment for Group I disorders?

Answer 22

Gonadotropin releasing hormones
Or gonadotropins with LH activity

Question 23

What do GnRH analogues do?
Group I treatment

Answer 23

Activate GnRH receptor on pituitary gland = increased secretion of FSH + LH

Question 24

What are examples of GnRH analogues?
Group I treatment

Answer 24

Buserelin
Goserelin
Nafarelin

Question 25

What can also be done in the treatment of Group I disorders?

Answer 25

Hyperprolactinemia treatment with dopamine agonists eg. Cabergoline

Question 26

What are the drugs for Group II?

Answer 26

Clomifene citrate Metformin BOTH

Question 27

How is Clomifene citrate used? Group II treatment

Answer 27

Given for 5 days started on cycle day 2-5 Should NOT be used for more than 6 cycles

Question 28

Why use Metformin? Group II treatment

Answer 28

Women with PCOS frequently experience insulin resistance

Question 29

What are the assisted reproductive technology?

Answer 29

Intrauterine insemination (IUI) In vivo fertilisation Intracytoplasmic sperm injection

Question 30

What is IUI?

Answer 30

Fast moving sperm placed into woman's womb close to time of ovulation

Question 31

When is IVF considered?

Answer 31

If unsuccessful after 6 cycles of IUI despite evidence of normal ovulation a further 6 cycles then IVF considered

Question 32

When is IUI considered?

Answer 32

Difficulty having sex due to disability or psychosexual problem Pain during intercourse Male impotence One partner has HIV Sperm donation used

Question 33

What is IVF?

Answer 33

Woman's eggs collected + fertilised manually with sperm If successful embryo developed for 2-6 days then transferred to womb

Question 34

Who is IVF for?

Answer 34

Woman with unexplained infertility Blocked fallopian tubes Male infertility Unsuccessful treatment with IUI

Question 35

What is the criteria for IVF?

Answer 35

Woman 21-39 BMI 19-30 Both non-smokers No living children from past or present relationships Both live at same address Stable relationship Neither sterilisation procedures

Question 36

What are the risks of IVF?

Answer 36

Ovarian hyperstimulation syndrome (OHSS) Ectopic pregnancy

Question 37

What is lifestyle advice?

Answer 37

Women with BMI less than 19 = irregular periods Both BMI over 30 = longer to conceive Smoking + drugs = affect egg + sperm quality Chlamydia + STIs