Fertility Flashcards
A semen analysis in a 33yo man shows azoospermia. Which of the following laboratory tests would be MOST LIKELY to be of value in determining the cause
a. Serum Prolactin
b. Serum FSH
c. Karyotype
d. Cystic Fibrosis gene studies
c. Karyotype
O
In patients who receive Clomiphene citrate (e.g. Clomid®) for induction of ovulation, the frequency of Ovarian Hyperstimulation Syndrome is:
a. <1%.
a. 5-10%.
b. 15-20%.
c. 25-30%
d. 35-40%.
a. <1%.
O
The effectiveness of postcoital contraception cannot be measured acurately by dividing the number of pregnancies that occur by the number of women treated because not all women would have become pregnant. The chance of pregnancy in a healthy nulligravida from a single act of intercourse a day prior to ovulation (the day of the LH surge) is about
a. 1%
b. 5%
c. 20%
d. 30%
e. 40%
c. 20%
O
The fertilised human ovum reaches the uterus APPROXIMATELY how long after ovulation
a. 36 hours
b. 5 days
c. 7 days
d. 9 days
b. 5 days
O
In which of the following potential causes of infertility has medical treatment been proven to enhance pregnancy rates compared with no treatment?
a. Ovarian failure due to resistant ovary syndrome
b. Antisperm antibodies in the female
c. Hyperprolactinaemia in an ovulatory woman
d. Anorexia nervosa
d. Anorexia nervosa
O
These women have hypothalamic dysfunction -> can given pulsatile GnRH analogue
A 27yo with hypothalamic amenorrhoea who desires pregnancy asks you about GnRH therapy for ovulation induction. You tell her that ovulation induction with GnRH is effective:
a. If the drug is administered as a continuous subcutaneous infusion until follicle maturation occurs
b. Only if HCG is used to trigger ovulation
c. Only if human menopausal gonadotrophins are used to trigger ovulation
d. If the hormone is administered in a pulsatile fashion
d. If the hormone is administered in a pulsatile fashion
O
All of the following are true about complications of clomiphene EXCEPT
a. Ovarian enlargement is seen in around 15% of women, but true hyperstimulation is rare
b. Major malformations in users of clomiphene citrate related pregnancies are not different from rates in an age-matched population
c. The chance of twins is approximately 20%
d. Pregnancy losses are similar to the normal population
c. The chance of twins is approximately 20%
O
60-85% ovulation rate
30-50% pregnancy rate
Multiples 5-7%
Following ovulation, the survival of the unfertilised human ovum is approximately
a. 12-24 hours
b. 24-48 hours
c. 2-3 days
d. 4-5 days
a. 12-24 hours
O
An important factor that enables a single follicle to become dominant over a pool of follicles undergoing recruitment in a normal ovarian cycle is
a. Progesterone production in the late follicular phase
b. Inhibin production in the follicles destined to undergo atresia
c. The oophorohypophyseal reflex
d. Production of follicular oestradiol
d. Production of follicular oestradiol
Oestradiol secreted by the granulosa cells surrounding the developing follicle
Oestradiol:
- Induces proliferative growth of the endometrium
- Gradually inhibits secretion of FSH (negative feedback)
When certain oestrogen threshold is reached, leads to reflex –> hypothalamus and pituitary to trigger ovulation via surge of LH and associated modest surge of FSH secretion (positive feedback)
The likelihood of twin pregnancy when ovulation is induced with clomiphene is:
a. < 1%
b. 5-10%
c. 15-20%
d. 25-30%
e. 30-40%
b. 5-10%
O
A 28yo woman and her husband have been infertile for two years. She has regular 28 day menstrual cycles, and all of her infertility investigations are normal, with patent tubes. Her husband’s semen analysis on several occasions shows sperm concentration 1 million/mL with 10% motility. The procedure MOST LIKELY to result in pregnancy is
a. IUI with husbands sperm
b. Artificial insemination with donor sperm
c. Gamete intrafallopian transfer
d. IVF with microinjection
d. IVF with microinjection
O
Semen volume
1.5ml (1.4-1.7)
Total sperm numbers
39 million spermatozoa per ejaculate (33-46)
Sperm concentrations
15 million spermatozoa per ml (12-16)
Total motility
40% (38-42)
Progressive motility
32% (31-34)
Sperm morphology
4% normal forms (3.0-4.0)
Vitality
58%
A couple is investigated for a 12 month history of primary infertility, and anovulation is identified as the underlying cause. Clomiphene is discussed as a first line treatment. Which statement about clomiphene is TRUE
a. Treatment is associated with teratogenic risk in 2% of cases
b. Treatment is associated with increased ovarian cancer risk in 5% of cases
c. Treatment is associated with multiple pregnancy in 5-10% of cases
d. Treatment is associated with OHSS in 15% of cases
c. Treatment is associated with multiple pregnancy in 5-10% of cases
O
Limit lifestyle usage to 12 cycles - risk of borderline ovarian tumours
OHSS <1%
A 30yo woman with 5 years of secondary amenorrhoea, galactorrhoea and infertility, is found to have a serum prolactin of 1200 [normal <400]. You recommend bromocriptine. You prescribe
a. 2.5mg daily with food
b. 5mg at night with food
c. 1.25mg at night, increasing over two weeks to 2.5mg twice daily with food
d. 1.25mg three times daily with food, increasing over two weeks to 2.5mg two or three times daily with food
c. 1.25mg at night, increasing over two weeks to 2.5mg twice daily with food
O
Ovulation CANNOT be induced with FSH in individuals with which of the following causes of amenorrhoea?
a. Galactosemia
b. PCOS
c. Hypothalamic hypogonadism (Kallman syndrome)
d. Hyperprolactinaemia
a. Galactosemia
O
90% have POI
Galactose accumulation is toxic to ovaries
A 32yo woman who has been infertile for four years has just completed the diagnostic phase of her fertility evaluation. Mid luteal progesterone, semen analysis, post coital test and HSG are all normal. A recent laparoscopy indicates moderate pelvic endometriosis (stage 3) without adhesions. Medical therapy for her endometriosis is recommended. She comes with lots of questions. You advise her
a. The pregnancy rate after medical therapy is unrelated to the initial stage of the disease
b. Danazol is most effective when administered as a once-a-day dose.
c. The degree of ovarian suppression achieved by GnRH agonists is greater than that achieved with Danazol
d. The availability of new medications makes medical therapy superior to operative therapy in terms of pregnancy rates following treatment
c. The degree of ovarian suppression achieved by GnRH agonists is greater than that achieved with Danazol
Which statement about oestrogen is NOT CORRECT
a. Oestrogen causes vasodilation
b. Oestriol synthesis in pregnancy is enhanced by aromatisation in the fetal adrenal gland
c. Oestrogen enhances the effect of Nitric oxide on vascular smooth muscle
d. Oestrogen is a positive inotrope
b. Oestriol synthesis in pregnancy is enhanced by aromatisation in the fetal adrenal gland
A 36-year-old female with a male partner presents with primary infertility for one year. Her periods are regular and she is ovulating based on a mid-luteal progesterone concentration. Her BMI is 25. They have no sexual difficulties. She has had a normal pelvic ultrasound and has patent tubes. The partner’s SA is 100 million/ml, motility 50%, abnormal forms 80%.
What is the best option to achieve pregnancy in the next 12 months?
a. Controlled ovarian hyperstimulation and intrauterine insemination
b. Continue trying to conceive spontaneous pregnancy for a further 12 months
c. She should consider an egg donor
d. Ovulation induction with clomid
a. Controlled ovarian hyperstimulation and intrauterine insemination
O
Sperm morphology - 4% normal forms (3.0-4.0)
- Cindy 2018 said - Clomiphene or letrozole with IUI is superior to expectant management and natural cycle IUI for outcome of livebirth rate in couples with unexplained infertility
How does high prolactin cause infertility?
a) Dopamine and GnRH
b) Failure of aromatase
c) Endometrial effect
d) Progesterone suppression of corpus luteum
a) Dopamine and GnRH
Amenorrhoea due to complete GnRH suppression
Milford
A couple with primary infertility for 4 years attend for review. The female is 40years old and the male is 36 years old. All investigations are normal. What is the BEST option to achieve pregnancy in the next 12 months?
A. Ovulation induction with Clomid
B. Intrauterine insemination
C. IVF
D. Using a donor egg
C. IVF
O
Reason for failure of bromocriptine treatment?
a. Under dosage
b. Non-compliance
c. Intolerance of symptoms
c. Intolerance of symptoms
Milford
A woman presents with 2 yrs of infertility. On laparoscopy mild endometriosis
was seen. Next management?
a. Laparoscopic diathermy
b. Danazol for 6 months
c. Progesterone
d. Combined OCP
e. Conservative management
a. Laparoscopic diathermy
Milford
UTD - even if mild endo, if symptomatic higher live birth rate with operative laparoscopy vs diagnostic only
A couple with infertility have a post-coital test performed on day 10 of the cycle. Scant mucous is present on the cervix. Best option is?
a. Give oestrogen for day 10-15 of the cycle
b. Use clomiphene in the next cycle
c. Repeat the test in 2-3 days
d. Advise AIH next cycle
e. Advise IVF next cycle
c. Repeat the test in 2-3 days
Most common reason for poor results is improper timing
Milford
Female undergoing IVF with Phx of PID/tubal blockage 5 days post T/V egg pick up has low abdo pain and vomiting. Most likely diagnosis:
a. OHSS
b. Vaginal haematoma
c. PID
d. Appendicitis
e. Torsion of ovary
a. OHSS
Milford
A man has azoospermia, normal
testicular size and normal male secondary
sex characteristics. Which of the following tests is most predictive of outcome?
a. Karyotype
b. Testosterone level
c. FSH
d. DHEAS
e. Seminal fructose
c. FSH
M
High FSH less chance of successful outcome
NOTE similar wording to different Q and official answer was karyotype
