Infertility ->

Question 1

Definition of infertility?

Answer 1

Inability to achieve clinical pregnancy w/in 1 year of having regular intercourse w/o contraception
(interchangeable with subfertility)

Question 2

Term that refers to the capacity to have a live birth?

Answer 2

Fecundity

Question 3

Term that refers to the probability of achieving pregnancy in a single menstrual cycle, regular sperm exposure, w/o contraception, resulting in a live birth?

Answer 3

Fecundability

Question 4

What is fertility?

Answer 4

The ability to achieve a clinical pregnancy

Question 5

What is sterility?

Answer 5

Permanent infertility

Question 6

What is ‘time to pregnancy’?

Answer 6

Length of time it takes a couple to conceive

Question 7

Normal fertility typically occurs within how many menstrual cycles of trying to conceive?

Answer 7

6

Question 8

Prevalence of females w/ infertility?

Answer 8

13%

Question 9

Rate of infertility varies depending on what?

Answer 9

Age

Question 10

Are ethnicity/race factors w/ infertility?

Answer 10

No

Question 11

85-90% of couples having unprotected sex will conceive within what length of time?

Answer 11

1 year

Question 12

Is sterility common?

Answer 12

No, 1-2% of couples

Question 13

Are males or females more commonly a factor of infertility cases?

Answer 13

Females

Question 14

Main cause of female infertility?

Answer 14

Ovulatory dysfunction and tubal factors

Question 15

Other factors that influence infertility?

Answer 15

Thyroid disorders, infection, structural abnormalities, obesity, testicular pathology (varicocele)

Question 16

When is a patient evaluation done for infertility if the patient us <35 y/o?

Answer 16

After 12 months

Question 17

When is a patient evaluation done for infertility if the patient us >35 y/o?

Answer 17

At 6 months

Question 18

Who can initiate an infertility evaluation?

Answer 18

PCP and OB/GYN

Question 19

Treatment for infertility is best provided by who?

Answer 19

An infertility specialist
*important that both partners present

Question 20

When evaluating for infertility, what will guide decision for diagnostic testing?

Answer 20

Thorough hx and physical

Question 21

What aspects of hx should be considered for female infertility?

Answer 21

Pubertal development, menstrual cycle characteristics, contraceptives, intercourse frequency, prior pregnancies/outcomes, GYN, surgical, infection, family hx, abnormal PAP/TX, medications, general health/lifestyle, social

Question 22

What aspects of hx should be considered for male infertility?

Answer 22

Congenital abnormalities, undescended testes, prior paternity, intercourse frequency, toxin exposure, surgical, infection (mumps), medications, general health/lifestyle, social, decreased frequency of shaving (lack of hair/testosterone levels low)

Question 23

Physical exam aspects for infertility?

Answer 23

Height, weight, BMI, BP, vitals, head & neck, abdominal, male/female GU/GYN, skin (dry -hypothyroid, acanthosis -PCOS), mental health

Question 24

What are the 4 key areas of assessment for infertility?

Answer 24

Sperm, oocyte, transport-fallopian tubes, implantation-uterus

Question 25

How long should a patient abstain from sex before collection of sperm sample for evaluation?

Answer 25

2-5 days

Question 26

Where should a sperm sample be taken?

Answer 26

In a lab or transported there within the hour

Question 27

How many semen samples should be taken for infertility evaluation?

Answer 27

2 samples a week apart

Question 28

If the first semen sample is abnormal, when should the test be repeated to confirm?

Answer 28

In 4-6 weeks

Question 29

Normal semen liquefaction?

Answer 29

30 minutes

Question 30

Normal semen count?

Answer 30

15 million/mL or more

Question 31

Normal semen motility?

Answer 31

>40%

Question 32

Normal semen volume?

Answer 32

1.5 mL

Question 33

Normal semen morphology?

Answer 33

4% normal forms

Question 34

How to confirm female ovulation in fertility evaluation?

Answer 34

Test: FSH, estradiol, serum progesterone, TSH, prolactin, LH (OTC ovulation kit available)

Question 35

How to evaluate pelvic factors in female fertility evaluation?

Answer 35

Pelvic exam, transvag US, hysterosalpingogram, laparoscopy* (sometimes)

Question 36

When is laparoscopy indicated in female pelvic factor eval?

Answer 36

If endometriosis or adhesions suspected

Question 37

How to evaluate cervical factors in female fertility eval?

Answer 37

Speculum exam, PAP smear

Question 38

Treatment of infertility depends on what factors?

Answer 38

Identifiable cause, age, duration of infertility, cost/insurance

Question 39

Male factor infertility treatment considerations?

Answer 39

Endocrine/systemic disorders, lifestyle changes, smoking cessation, surgery, intra cytoplasmic sperm injection (ART), donor sperm

Question 40

There is an increased risk of what with intra cytoplasmic sperm injection (ART)?

Answer 40

Genetic disorders

Question 41

What is ICSI?

Answer 41

Sperm is injected into a retrieved egg's cytoplasm using a fine needle

Question 42

Female factor infertility treatment considerations?

Answer 42

Ovulation induction: Clomiphene (Letrozole for PCOS - off label), IVF/embryo transfer (ART), donor egg, surgery, weight loss, smoking cessation, adoption/surrogacy/no tx

Question 43

What is the process of IVF?

Answer 43

Ova are aspirated by transvag US probe w/ needle attached, sperm introduced to egg, embryo transferred into uterus