Infertility

Question 1

How long does regular menstrual cycle last?

Answer 1

Around 28-35 days

Day 1 is first day of bleeding

Question 2

How many days does luteal phase last?

Answer 2

Constant 14 days

Question 3

How long does bleeding usually last in menstrual cycle?

Answer 3

3-8 days

Question 4

How is bleeding in menstrual cycle displayed in a report?

Answer 4

Annotated as 7/28 or 5-6/27-32

Where:

no of days bleeding/no of days menstrual cycle

Question 5

Definition of oligomenorrhoea?

Answer 5

cycles >35 days

Question 6

What is amenorrhoea and what are the 2 types?

Answer 6

Absence of menstruation

Can be primary or secondary

Primary: defined as the failure to reach menarche. Menarche occurs between the ages of 10 and 16, with the average age of onset being 12.4 years.

Secondary: the absence of three or more periods in a row by someone who has had periods in the past. Most common cause being pregnancy but also associated with other underlying issues.

Question 7

What hormone peaks following ovulation?

Answer 7

Progesterone

Question 8

A surge in what hormone triggers ovulation?

Answer 8

LH

Question 9

What is involved in an infertility consultation?

Answer 9

Patients seen as couple
Establish length of relationship
Length of time trying to get pregnant

Female
- History
- Examination / Ultrasound scan
- Investigations
Male
- History
- Diagnostic semen analysis
- Examination
- Investigations

Question 10

Abnormal findings that can be seen on transvaginal ultrasound?

Answer 10

Congenital uterine abnormalities

Fibroids

Endometrial polyp

Hydrosalpinx (when fallopian tube is blocked and fills with clear or serous fluid near ovary - distal to uterus).

PCOS

Ovarian cyst
- Simple
- Dermoid
- Cancer
- Endometrioma

Question 11

What is a hysterosalpinogram (HSG)?

Answer 11

an X-ray procedure that is used to view the inside of the uterus and fallopian tubes. It often is used to see if the fallopian tubes are partly or fully blocked.

This is first line for testing tubal patency (if there any blockage with tubes)

Used if laparoscopy is contraindicated due to obesity, previous pelvic surgery, Crohn’s disease etc.

Question 12

When is hysteroscopy performed?

Answer 12

Inspection of uterine cavity using endoscope with access through the cervix.

Only performed in cases where suspected or known endometrial pathology: i.e. uterine septum, adhesions, polyp

Question 13

Lifestyle aims and advice for infertility?

Answer 13

Aim to optimise chances of conception
Reduce risks for pregnancy
Be able to access Assisted Conception if needed

Stop smoking
BMI 18.5 – 30
Reduce / stop alcohol consumption
Moderate caffeine
Stop recreation drugs / methadone
Folic acid