Fertility Management

Question 1

What are the surgical contraceptive methods?

Answer 1

Vasectomy

Tubual ligation

Question 2

What are the advantages and disadvantages of a vasectomy?

Answer 2

Advantages
No sex interruption
Continuous protection

Disadvanatges
3 month wait to be sterile
Expensive
Irreversible
No STI protection

Question 3

What are the advantages and disadvantages of Tubal ligation

Answer 3

Advantages
No sex interruption
Continuous protection
Decreased risk of ovarian cancer

Disadvantages
Expensive
Irreversible
No STI protection

Question 4

What are the hormonal contraceptive methods?

Answer 4

COC (combined)

POC (progesterone only)

Question 5

What is POC (hormnal contraceptive)

Answer 5

Progesterone Only Hormone

thickens cervical mucous

Question 6

What are the contracindications of POC?

Answer 6

stroke

breast cancer

Question 7

What is COC

Answer 7

Combined Estrogen and Progesterone

Question 8

What is the action of COC?

Answer 8

Supresses follicle stimulation, ovulation and CL formation

Thickens cervical mucous

Disrupts oviduct transport and creates hostile endometrium

Question 9

Adv and disAvd of COC

Answer 9

Adv
Works at 3 levels
Decreases risk of ovarian cancer
Regular and lighter menses

DisAdv
Prescription
Daily use
No STI protection
Nausea, breast tenderness and headaches

Question 10

Contrainindication of COC

Answer 10

CV complications

Breast cancer

Postpartum breastfeeding (blocks PRL)

Question 11

Adv and DisAdv of Condoms

Answer 11

Adv
STI protection
Nonprescription

DisAdv
Interrupts sex
Single-use

Question 12

What is a Diaphragm used for and what are the disadvantages of it?

Answer 12

Prevents movement of sperm in female repro tract

DisAdv
Prescription
Requires fitting
Timing

Question 13

What is spermicide and what are its Adv and DisAvds

Answer 13

What
Prevents movement of sperm through female repro tract

Adv
Some STI protection
Nonprescription

DisAdv
Unpleasant for some
Time-sensitive

Question 14

What is the action of an IUD and what are its Adv and DisAdvs

Answer 14

Prevents implantation of blastocyst

Adv
Effective for years
No sex interruption

DisAdv
Prescription
Painful

Question 15

What are the natural methods for contraception?

Answer 15

Withdrawal

Rhythm method

Breast feeding

Question 16

What are the barrier/chemical contraceptive methods of contraception?

Answer 16

Condom
Diaphragm
Spermicide
IUD

Question 17

Compare the failure rates of the contraceptive methods.

Answer 17

Surgical - lowest failure
hormonal = relatively effective
barrier = high failure
natural = least reliable

Question 18

What hormones can be targeted for male contraception

Answer 18

inhibin: suppresses FSH (unsupported Sertoli cells and no ADP)

ABP: -revent sequestration of testosterone to sertoli cells )

FSH:

Question 19

What precautions must be made when consideration hormonal targets for males

Answer 19

Must avoid disrupting endogenous testosterone levels

Question 20

What techniques of contractception are used before fertilisation?

Answer 20

Male
vasectomy
Abstinence
Condom
Coitus Interruptus

Female
COC, monthly injection, vaginal ring
Abstinence
feae condom
tubal ligation
spermicides, diaphragm

Question 21

What contraceptive methods are used during transport down the male duct?

Answer 21

Abstinence (male and female)
condom (male and female)
coitus interruptus

Question 22

Clinical infertility vs Sterility

Answer 22

Clinical infertility = inability to conceive after 12months of freq unprotected intercourse

Sterility = cannot conceive

Question 23

Fecundability vs fecundity

Answer 23

Fecundability = probability of achieving pregnancy in 1 menstrual cycle

Fecundity = Probability of achieving pregnancy resulting in live birth in 1 menstural cycle.

Question 24

What are the (5) main causes of male infertilty?

Answer 24

Poor sperm number/motility/ morphology

Tetes and accessory gland dysfunction

Blocked ejaculatory tracts

Retrograde/ neurological ejaculation disorders

Anti-sperm antibodies

Question 25

What are the 5 main causes of female infertility?

Answer 25

Ovulation and ovarian failure Implantation failure Failed sperm transport Blocked oviducts Anti-sperm antibodies

Question 26

What can cause ovulation and ovarian failure?

Answer 26

hormone imbalance, PCOS and hypoplasia

Question 26

What can cause implantation failure?

Answer 26

Abnormal endometrium, fibroids/polyps and hormone imbalance

Question 27

What can cause failed sperm transport

Answer 27

Vaginal avid and abnormal cervical shape

Question 28

What can cause poor sperm number/motility/ morphology?

Answer 28

hormone imbalance and hypogonadism

Question 29

What can cause tetes and Accessory gland dysfunction?

Answer 29

Cryptorchidism (a condition in which one or both of the testes fail to descend), varicocele (englagement of veins inside scrotum) and drugs/toxins

Question 30

How is the cause of infertility determined?

Answer 30

Primary analysis Hormone assays Ultrasound Test tubual patency Semen analysis Blood tests Secondary analysis Laparoscopy and endoscopy Endometrial/ testicular biopsy

Question 31

Hormone assays

Answer 31

– detects cycying, ovulation and spermatogenesis

Question 32

Ultrasound use in testing infertility

Answer 32

presence of follicles or cysts and endometrial thickness

Question 33

What is looked for in a test of tubal patency?

Answer 33

blockages and occlusions (hidden or obscured)

Question 34

what is looked for in a semen analysis?

Answer 34

number and morphology of sperm

Question 35

What is looked for in a blood test during the primary analysis of infertilty?

Answer 35

anti-sperm antibodies

Question 36

What does a laparoscopy or endoscopy in the secondary analysis of infertility look for?

Answer 36

Laparoscopy and endoscopy – uterine and oviduct blockage

Question 37

What terms are used to refer to sperm count?

Answer 37

Aspermia Azoospermia Oligozoospermia Normospermia

Question 38

Aspermia

Answer 38

NO ejaculate (accessory gland affected)

Question 39

Azoospermia

Answer 39

No Sperm

Question 40

Oligozoospermia

Answer 40

Less than 15million/ mL

Question 41

Normospermia

Answer 41

Greater than 15million/ mL

Question 42

What are the main types of Assistive Repro Technologies?

Answer 42

Artificial insemination (AI) In Vitro Fertilization (IVF) Intracytoplasmic sperm injections (ICSI) Zygote intrafallopian transfer (ZIFT) Gamete intrafallopian transfer (GIFT) Cryopreservation of sperm, oocytes or embryo

Question 43

Describe Artificial insemination

Answer 43

Most motile/functional perm isolated Intrauterine insemination by catheter Synchronised with natural or induced ovulation

Question 44

IVF

Answer 44

Oocyte retrieved from ovary Sperm is capacitated Natural penetration, fusion and fertilization IN VITRO Embryo cultured in vitro Blastocyst transferred to uterus

Question 45

Describe the process of intracytiplasmic sperm injections

Answer 45

Fertilization incompetent sperm directly injected into oocyte Injected oocyte is chemically activated with Ca

Question 46

Describe the process of Zygote intrafallopian transfer (ZIFT)

Answer 46

Like IVF however transferred into oviduct

Question 47

Describe the process of Gamete intrafallopian transfer (GIFT)

Answer 47

Oocyte transferred to oviduct to bypass blockage

Question 48

Suggest the best methods for males with: a) Suboptimal motility or count b) Very poor motility or count c) Immotility

Answer 48

a- AI B- IVF C- ICSI (directly into oocyte)

Question 49

Suggest the best ART methods for females with: a) Tubual blockage b) Tubual blockage AND very poor sperm motility/ count

Answer 49

a= GIFT b= IVF or ZIFT

Question 50

Adv and DisAdv of POC

Answer 50

Adv Don’t get the contraindications associated with Estrogen (COC) DisAdv prescription daily use decreased protection compred to COC

Question 51

When do most make contraception methods occur?

Answer 51

BEFORE fertilisation (women can do after)

Question 52

Why is there a higher risk of having a child with down syndrome in older mothers rather than older fathers?

Answer 52

Cohesive proteins keep sister chromatids apart. These weaken with age = -incorrect microtubule-centromere attachment -non-disjunction

Question 53

What is the formula for sperm concentration?

Answer 53

mean sperm number X square multiplication factor X dilution Square multiplication factor = 10^4 (large) or 5x10^4 (small) dilution factor = 2 for a dilution factor of 1/2

Question 54

What is the formula for the total number of ejaculated sperm?

Answer 54

= sperm conc x total ejaculate volume