Infertility

Question 1

Define infertility

Answer 1

inability of heterosexual couple to conceive within 12 months

Question 2

Difference between primary and secondary infertility?

Answer 2

primary= no previous pregnancies

Question 3

List three factors that affect fertility

Answer 3

Female age
Previous pregnancy
Timing of intercourse
Weight (low or high BMI)

Question 4

What is the viability of sperm within female?

Answer 4

72 hours

Question 5

How often should people have sex to conceive?

Answer 5

2-3 times/week

Question 6

List two issues associated with increased weight

Answer 6

miscarriage
gestational diabetes
PE
DVT
PIH= pregnancy induced hypertension

Question 7

How to assess semen?

Answer 7

Volume
Concentration
Total motility
Progressive motility
Normal forms
Vitality
(WHO standard)

Question 8

How does semen collection work?

Answer 8

Sample provided after 3-5 days of abstinence and must be analysed in lab within 1 hour of being produced

Question 9

What might cause low concentration? =oligospermia

Answer 9

genetic abnormality- kleinefelter’s
Cystic fibrosis
Y microdeletion

Question 10

List three investigations for oligospermia/azoospermia

Answer 10

karyotypr
Y microdeletion
CF status
FSH
SSR

Question 11

Define azoospermia

Answer 11

no sperm production

Question 12

List two causes of azoospermia

Answer 12

1. Obstructive- blockage or epididymis or vas deferns, congenital absence of vas deferens
2. Non obstructive
   - testicular failure (high FSH, e.g. kleinefleter’s), or low FSH (hypogonadotrophic hypogonadism)

Question 13

Couple struggling to conceive. Man has azoospermia and low FSH. What condition does he have?

Answer 13

hypogonadotrophic hypogonadism

Question 14

When is baseline level test done?

Answer 14

Day 1-3

Question 15

Which days to test ovulation?

Answer 15

based on 28 day cycle, if 30 day cycle then you do day 21 +2= day 23.

Question 16

What is the WHO classificaiton of irregular or no cycle?

Answer 16

group 1- primary or secondary amennorrhoea

group 2

group 3

Question 17

What are the causes of group 1 amenorrhoea/irregular menses?

Answer 17

weight
stress
exercise
craniopharygioma
kallman’s syndrome

Question 18

What is the physiological cause of group 1 irregular cycle?

Answer 18

hypothalmic pituitary failure

Question 19

What are the levels of FSH, LH, E2 in group 1 patients?

Answer 19

Low FSH, low LH, low E2

Question 20

What is the management of group 1?

Answer 20

GnRH agonist
FSH/LH

Question 21

What happens to the feedback cycle in group 2?

Answer 21

hypothalamic pituitary dysfunction

Question 22

Which is the main condition associated with hypothalamic pituitary dysfunction?

Answer 22

PCOS/PCO

Question 23

Name two other conditions associated with group 2

Answer 23

hyperprolactinaemia
hypothyroid
hyperthyroid
adrenal insufficiency

Question 24

How to test group 2?

Answer 24

induce withdrawal bleed with progesterone
hormone tests day 1 and day 3

Question 25

What are the hormone levels in group 2?

Answer 25

E2 normal prolactin norma increased free androgen index reversed FSH/LH ratio

Question 26

How to diagnose PCOS

Answer 26

2/3 features Rotterdam criteria 1. Clinical or biochemical evidence 2. Oligomenorrhoea/amenorrhoea 3. USS findings

Question 27

String of pearls in ovary is a sign of?

Answer 27

PCOS

Question 28

What is the most common cause of anovulatory infertility?

Answer 28

PCOS

Question 29

What is the effect of PCOS on fertility

Answer 29

oocyte quality= poor ovulatory function endometrial receptivity +secondary to obesity, metabolic and inflammatory disturbance Cause= hormone imbalance and insulin resistance (increase in testosterone)

Question 30

What is the management of PCOS?

Answer 30

weight loss!! ovarian drilling? Letrozole= 1st line

Question 31

What is the MOA of letrozole?

Answer 31

aromatase inhibitor blocks oestrogen biosynthesis, blocks negative feedback, increase FSH, ovulation stimulation

Question 32

WHat is the original use of letrazole?

Answer 32

breast cancer (anti-oestrogenic effect)

Question 33

Other than latrazole, name one other agent to treat infertility in PCOS

Answer 33

clomiphene

Question 34

What is the MOA of clomiphene

Answer 34

Selective oestrogen receptor modulator

Question 35

What is the risk of clomiphene

Answer 35

ovarian cancer risk

Question 36

How to improve fertility in PCOS?

Answer 36

weight loss latrozole or clomiphene IVF

Question 37

What is the cause of group 3?

Answer 37

ovarian failure/insufficiency (pituitary/hypothalamus fine)

Question 38

What happens to the levels of FSH and E2 in group 3?

Answer 38

increased FSH Reduced E2

Question 39

List three causes of group 3?

Answer 39

idiopathic chemo surgical removal of ovaries autoimmune chromosomal turner's syndrome androgen insensitivity (46 XY but Y is unresponsive) fragile X

Question 40

What is the management of group 3 in regard to having children?

Answer 40

oocyte donation with IVF adoption fostering embryo donation accept childlessness

Question 41

What are the components of the holy triad?

Answer 41

Fallopian tubes oocyte sperm (+endometrium, uterus anomalies)

Question 42

What is the elgibility for IVF treatment?

Answer 42

<43 years by the time treatment is completed BMI 18.5-30 No smoking for at least 3 months no smoking no biological child from either partner no sterilisation cohabiting stable relationship for >2 years

Question 43

What is ICSI?

Answer 43

single sperm injucted into a mature egg (increased risk of congenital abnormality)

Question 44

What is the technique for IVF?

Answer 44

sperm fertilised egg on its own (sperm has to do the work itself)

Question 45

What is IUI?

Answer 45

directly inserting sperm into uterus (female same sex)

Question 46

Can someone with hep B/C/HIV have IVF?

Answer 46

yes! specialised centres

Question 47

What is ovarian hyperstimulation?

Answer 47

ovaries over respond to gonadotrophin injections

Question 48

What are the complications of ovarian hyperstimulation?

Answer 48

thrombosis renal dysfunction liver dysfunction adult respiratory distress syndrome

Question 49

Why do complications arise with ovarian hyperstimulation?

Answer 49

release of vasoactive producted from hyperstimulated ovaries

Question 50

Which condition increases the risk of ovarian hyperstimulation?

Answer 50

PCOS