Fertility, Subfertility And Infertility

Question 1

Subfertility

Answer 1

Delayed/reduced capacity to conceive

Question 2

Infertility

Answer 2

reproductive system disease defined by failure to achieve clinical pregnancy after 12 months of regular unprotected sex with no other reason

Question 3

Primary infertility

Answer 3

Couple have never been able to conceive

Question 4

Secondary infertility

Answer 4

Person has had first baby with no difficulty then cannot get pregnant again, or has conceived and has miscarriage or ectopic

Question 5

What is a main cause of rising infertility rates

Answer 5

Having children later in life

Question 6

How does age affect fertility

Answer 6

Decrease, women more than men

Question 7

When does female fertility start decreasing dramatically

Answer 7

30

Question 8

How long after ovulation is an egg viable

Answer 8

~2 days

Question 9

Female causes of infertility

Answer 9

Erratic ovulation
Blocked uterine tubes
Endometriosis
Pituitary or ovarian tumour
Pelvic inflammatory disease
Antisperm antibodies
Age

Question 10

4 classes of ovulatory causes of infertility

Answer 10

Hypothalamic
Pituitary
Ovarian
PCOS

Question 11

Hypothalamic ovulatory causes of infertility

Answer 11

Hypothalamic amenorrhea
Anorexia
Genetic
Autoimmune GAIN
Iatrogenic
Neoplasm

Question 12

Pituitary ovulatory causes of infertility

Answer 12

Hyperprolactaemia - decreased LH and FSH
Functional
Infectious. FIT
Inflammatory
Trauma+Vascular

Question 13

Ovarian ovulatory causes of infertility

Answer 13

Premature ovarian failure
Physiological
Idiopathic. PIE
Endocrine

Question 14

What are the 3 components of the Rotterdam criteria and how many are needed for a PCOS diagnosis

Answer 14

Clinical hyperandrogenaemia
Oligomenorrhea
Polycystic ovaries on ultrasound - 12+ follicles
2/3 needed

Question 15

Oligomenorrhea

Answer 15

Less than 6-9 periods per year

Question 16

PCOS symptoms

Answer 16

Menstrual disturbance
Infertility
Hirsutism
Acne
Male pattern hair loss
Central obesity
Acanthosis nigricans

Question 17

Hormone abnormalities in PCOS

Answer 17

Raised LH with normal FSH
Raised free testosterone >5ng/L
AMH >3.5ng/mL

Question 18

Why are metabolic abnormalities associated with PCOS

Answer 18

Abnormal serum lipid concentrations
Insulin resistance

Question 19

Tubal and uterine causes of infertility

Answer 19

Pelvic inflammatory disease
Previous tubal surgery
Endometriosis
Fibroids
Cervical mucus defect

Question 20

Endometriosis

Answer 20

Presence of tissue similar to endometrium outside uterus, often on uterus, Fallopian tubes, or GI system

Question 21

Why does endometrial tissue outside uterus grow and bleed in endometriosis

Answer 21

Tissue responds to oestrogen and progesterone

Question 22

What causes pelvic inflammatory disease

Answer 22

Bacterial infection spreading from vagina or cervix

Question 23

Fibroid/leiomyoma

Answer 23

Non cancerous smooth muscle growth

Question 24

Fibroid/leiomyoma symptoms

Answer 24

Heavy periods
Pain on intercourse
Abdominal swelling

Question 25

Fibroid types

Answer 25

Redunculated subserosal - abdominal Subserosal Submucosal Intramural Redunculated submucosal - vaginal

Question 26

Repeated miscarriage causes and treatments

Answer 26

Anatomical abnormalities - no treatment Cervical incompetence - close cervix Endocrine/hormonal abnormalities - hormone blockers Genetic/chromosomal abnormalities - no treatment Blood coagulation protein/platelet defects - low dose aspirin B CAGE

Question 27

Most common cause of repeated miscarriage

Answer 27

Blood coagulation protein abnormalities

Question 28

Blood coagulant protein/platelet defects that can cause repeated miscarriage

Answer 28

Factor XIII defects Factor XII defects Anticardiolipin antibodies Lupus anticoagulant Antophospholipid syndrome

Question 29

Endocrine abnormalities that can cause repeated miscarriage

Answer 29

Luteal phase defect LH hypersecretion on day 8

Question 30

Is infertility easier to detect and treat in men or women

Answer 30

Easier to detect in men Easier to treat in women

Question 31

Male causes of infertility

Answer 31

<120 million sperm Hormone imbalance Anti sperm antibodies Varicocele Sperm quality and movement Undescended testis Obstruction - vasectomy, cystic fibrosis Ejaculatory problems - premature, retrograde Erectile dysfunction

Question 32

Combined infertility

Answer 32

Both man and woman infertile or subfertile

Question 33

Genetic causes of infertility

Answer 33

NR5A1 gene mutations 46XY

Question 34

Male idiopathic infertility

Answer 34

Semen analysis abnormal but unclear why

Question 35

Female idiopathic infertility

Answer 35

Ovulation abnormal but unclear why

Question 36

Why can a MTHFR gene mutation cause infertility

Answer 36

Folate deficiency as Cannot convert folic acid to folate

Question 37

General advice to improve conception

Answer 37

Intercourse throughout cycle Stop smoking Stop/decr alcohol Take folic acid Lose weight Decr stress Decr caffeine

Question 38

GP investigations before referral

Answer 38

Sexual/ contraception/family history PCOS screen Thyroid function Vitamin D HbA1C Viral screen STI screen Semen analysis

Question 39

When are women referred by a GP to infertility services

Answer 39

Aged 36+ and known clinical cause

Question 40

What is assessed in a semen analysisf

Answer 40

Volume - lower limit 1.5ml Progressive motility - lower limit 32% Morphology - lower limit 4% DNA integrity

Question 41

Ovulatory function investigations

Answer 41

Blood test Response to gonadotropin stimulation in IVF, ultrasound, hormones - ovarian reserve Hysterosalpingogram - tubal function Laparoscopy - uterine function

Question 42

Assisted reproductive options

Answer 42

Intrauterine insemination In vitro fertilisation Intra cytoplasmic sperm injection

Question 43

Intrauterine insemination

Answer 43

Sperm collected and slow sperm removed then inseminated into parter/donor

Question 44

IVF

Answer 44

Sperm and eggs collected, Eggs fertilised outside body then inseminated

Question 45

How many cycles of IVF are offered and when

Answer 45

3 if woman under 40 1 if woman 40-42 and never previously had IVF and no evidence of low ovarian reserve Offered after 2yrs unprotected intercourse or 12 cycles IUI

Question 46

intracytoplasmic sperm injection

Answer 46

Single spermatic injected directly into egg

Question 47

Who is IUI offered to

Answer 47

Unable to have vaginal intercourse Sperm wash needed

Question 48

Who is ICSI offered to

Answer 48

Severe sperm deficiency Obstructive azoospermia Non obstructive azoospermia Previous Failed IVF

Question 49

What causes ovarian hyperstimulation syndrome

Answer 49

Drugs used to stimulate ovarian function in IVF or PCOS, esp hCG

Question 50

Ovarian hyper stimulation syndrome

Answer 50

Multiple luteinised cysts in ovaries due to drugs used to stimulate ovaries

Question 51

What risks are slightly increased in children born by IVF to mothers over 35

Answer 51

Birth defects Cancer

Question 52

Types of 3rd party reproduction

Answer 52

Egg donation Sperm donation Embryo adoption Surrogacy

Question 53

What precautions can be taken for cancer patients who wish to have children in the future

Answer 53

Cryopreservation of sperm, embryos, or oocytes