Infertility

Question 1

Incidence

Answer 1

1 in 7 couples

Question 2

Risk factors

Answer 2

Age
Smoking
BMI (<18 and >30)
Steroids (sperm)
Seat warmers for sperm

Question 3

Who can be referred before 1 year

Answer 3

Age 36 and over
Known clinical cause or risk factors

Question 4

Ovulatory disorders cause what proportion of infertility

Answer 4

21%

Question 5

Normal range mid-luteal progesterone

Answer 5

> 30

Question 6

Tubal disease causes what proportion of subfertility

Answer 6

14%

Question 7

Semen analysis parameters

Answer 7

Volume >1.5ml
Concentration 15m
Normal forms 4%
Motility 40%
Total sperm 39m
Vitality 58% or more live spermatazoa

Question 8

Main cytokine implicated in OHSS

Answer 8

VEGF

Question 9

Pathophysiology of OHSS

Answer 9

Ovarian enlargement
Systemic effects of inflammatory mediators
Increased vascular permeability
Prothrombotic effect

Question 10

OHSS incidence

Answer 10

3-8% for moderate and severe disease
Mild in 1/3 of traditional IVF

Question 11

OHSS triggers

Answer 11

IVF
Clomiphene
Monofollicular ovulation induction gonadotrophin induction
Pregnancy

Question 12

Risk factors for OHSS

Answer 12

Previous OHSS
PCOS
Increased AFC
High levels of AMH
Successful conception after IVF
Multiple pregnancy after IVF

Question 13

Symptoms of OHSS

Answer 13

Abdominal distension and pain
Nausea and vomiting
SOB
Oliguria
Oedema
Thrombosis

Question 14

Classification of OHSS

Answer 14

Early - within 7 days of HCG trigger

Late - 10 or more days after HCG trigger

Question 15

Investigations for suspected OHSS

Answer 15

Bloods - FBC, CRP, LFT, U&E, clotting, serum osmolality, ABG

ECG
CXR
USS
CTPA

Question 16

Examination in OHSS

Answer 16

Hydration status
Oedema
Obs
Body weight
Abdominal girth
Palpable mass
Pleural effusion or pulmonary oedema

Question 17

Mild OHSS

Answer 17

Abdominal bloating
Mild pain
Ovarian size <8cm3

Question 18

Moderate OHSS

Answer 18

Moderate abdominal pain
Nausea and vomiting
Ascites on USS
Ovary size 8-12cm3

Question 19

Severe OHSS

Answer 19

Clinical ascites +/- hydrothorax
Oliguria
Haematocrit > 0.45
Hyponatraemia <135
Hypo-osmolality <282 mOsm/kg
Hyperkalaemia >5
Hypoalbuminaemia
Ovarian size >12cm3

Question 20

Critical OHSS

Answer 20

Tense ascites/large hydrothorax
Haematocrit >0.55
WCC >25
Anuria
VTE
ARDS

Question 21

Causes of death with OHSS

Answer 21

Renal failure
ARDS
Ovarian rupture
VTE

Question 22

OHSS duration

Answer 22

7-10 days

Question 23

Hospital admission for OHSS

Answer 23

Worsening symptoms
Uncontrolled pain
Inadequate oral intake
Unable to attend for follow up
Critical OHSS

Question 24

Indications for paracentesis in OHSS

Answer 24

Severe abdominal pain secondary to ascites
Dyspnoea secondary to ascites
Oliguria despite fluid replacement due to compression of ascites causing hypoperfusion to kidneys

Question 25

Incidence of thrombosis in OHSS

Answer 25

0.7-10%

Question 26

Pregnancy complications from OHSS

Answer 26

PET
PTB