Infertility

Question 1

Infertility is failure to achieve a clinical pregnancy after at least ____ months of regular unprotected sex in a couple who have never had a child

Answer 1

12

Question 2

Primary infertility

Answer 2

Couple have never conceived

Question 3

Secondary infertility

Answer 3

Couple have previously conceived but have lost the baby during pregnancy

Question 4

Causes

Answer 4

Older women trying to conceive 
Increasing male factor fertility
Rise in chlamydia infections 
Increase in obesity
Same sex couples 
Increased awareness of treatments 
Endometriosis 
Ovulatory dysfunction
Tubal disorder

Question 5

Female investigations

Answer 5

General exam: BMI, body hair distribution
Pelvic exam
Midluteal progesterone levels 
Endocervical swab for chlamydia 
Test tubal patency

Question 6

What are normal mid luteal progesterone levels

Answer 6

over 30nmol/L in 2 separate samples

Question 7

Male investigations

Answer 7

General exam: BMI
Genital exam: size and position of testes
Semen analysis
Measure LH, FSH, testosterone, prolactin, thyroid function
Chromosomal analysis

Question 8

Female causes of infertility (4)

Answer 8

Anovulatory infertility
Tubal disease
Hydrosalpinx
Endometriosis

Question 9

Anovulatory infertility - definition

Answer 9

Overies don’t release an egg

Thus ovulation does not occur

Question 10

Anovulatory infertility - physiological causes

Answer 10

Before puberty
Pregnancy
Menopause

Question 11

Anovulatory infertility - hypothalamic causes

Answer 11

Anorexia
Bullimia
The ovaries don’t release an egg as the patient is not healthy enough)

Question 12

Anovulatory infertility - pituitary causes

Answer 12

Tumours

Question 13

Anovulatory infertility - ovarian causes

Answer 13

PCOS

Premature ovarian failure

Question 14

Anovulatory infertility - endocrine causes

Answer 14

Testosterone secreting tumours

Congenital adrenal hyperplasia

Question 15

Anovulatory infertility - drug causes

Answer 15

Explanon
OCP
Depo-provera

Question 16

Tubal disease - definition

Answer 16

Fallopian tubes are blocked/damaged

This restricts the egg from making the journey from the ovary to the uterus

Question 17

Tubal disease - infective causes

Answer 17

Chlamydia
Appendicitis (transperitoneal spread)
Hysteroscopy

Question 18

Tubal disease - non-infective causes

Answer 18

Endometriosis
Fibroids
Polyps
Surgery

Question 19

Tubal disease - investigations

Answer 19

Hydrosalpinogram

Laparoscopy - if there is known previous pathology

Question 20

Tubal disease - management

Answer 20

Tubal surgery

IVF

Question 21

Hydrosalpinx - definition

Answer 21

Distally blocked fallopian tube filled with clear fluid

Question 22

Hydrosalpinx - clinical features

Answer 22

Abdominal / pelvic pain 
Vaginal discharge
Dyspareunia 
Infertility - ectopic pregnancy 
Dysmennorrhoea

Question 23

Hydrosalpinx - management

Answer 23

IVF treatment

Question 24

Endometriosis - definition

Answer 24

Presence of endometrial glands outside the uterine cavity

i.e. the lining of the womb comes outside of the womb

Question 25

Endometriosis - clinical features

Answer 25

``` Dysmennorrhoea Dyspareunia Chronic pelvic pain Excessive bleeding Infertility ```

Question 26

Endometriosis - investigations

Answer 26

"chocolate cysts" on ovary

Question 27

Endometriosis - management

Answer 27

Pain relief

Question 28

Male non-obstructive causes of infertility

Answer 28

Torsion Trauma Iatrogenic - chemotherapy, radiotherapy Chromosomal abnormality - klinefelters

Question 29

Non obstructive male infertility - endocrine features

Answer 29

Increased FSH Decreased LH Decreased testosterone

Question 30

Non obstructive male infertility - clinical features

Answer 30

Reduced secondary sexual characteristics

Question 31

Obstructive male infertility - causes

Answer 31

Congenital absence of vas deferens (e.g. CF) Infection Vasectomy

Question 32

Obstructive male infertility - endocrine features

Answer 32

Normal FSH Normal LH Normal testosterone (all hormones are normal, there is just an obstruction)

Question 33

Obstructive male infertility - clinical features

Answer 33

Normal secondary sexual characteristics | Vas deferens may be absent

Question 34

Obstructive male infertility - management

Answer 34

Surgery to obstructed vas deferens Intrauterine insemination Sperm injection