Infertility

Question 1

Give some of the main reasons couples seek ART

Answer 1

Endometriosis 
Male factor
Tubal disease
Ovulatory disorder
Idiopathic

Question 2

What advice should be given to couples before starting ART?

Answer 2

4 units alcohol per week (woman)
BMI 19-29
Stop smoking
Folate supplement
Rubella immunisation

Question 3

What are the main ART treatments?

Answer 3

Donor insemination
Intra-uterine insemination (IUI)
In-vitro fertilisation (IVF)
Intra-cytoplasmic sperm injection (ICSI)

Question 4

What occurs in intra-uterine insemination?

Answer 4

Prepared semen inserted into uterine cavity at time of ovulation

Question 5

Give some indications for IVF

Answer 5

Unexplained infertility
Pelvic disease
Anovulatory infertility

Question 6

What is the first step of IVF?

Answer 6

Down regulation - synthetic GnRH given to time ovulation

Question 7

What occurs after down regulation?

Answer 7

The ovary is stimulated with high dose gonadotrophin

Question 8

After ovary stimulation what occurs?

Answer 8

Oocyte collected in theatre

Question 9

What occurs once the oocyte has been collected?

Answer 9

Fertilisation using sperm

Question 10

How many days after fertilisation is the embryo transferred?

Answer 10

5

Question 11

Give some indications for intra cytoplasmic sperm injection

Answer 11

Severe male infertility

Previous failed fertilisation

Question 12

In ICSI, what procedure is carried out if the man has azoospermia?

Answer 12

Surgical sperm aspiration

Question 13

What is the main complication of ART?

Answer 13

Ovarian hyperstimulation syndrome

Question 14

What occurs in ovarian hyperstimulation syndrome?

Answer 14

Too many eggs are produced

Question 15

Give some clinical features of OHSS

Answer 15

Ascites
Oliguria
Thromboembolism
Renal failure

Question 16

How can OHSS be treated?

Answer 16

Reduce thrombosis risk (fragmin)

Single embryo transfer

Question 17

Why are rates of multiple pregnancy in ART decreasing?

Answer 17

As there is a move to blastocyst transfer

Question 18

There is an increased incidence of ectopic pregnancy in ART. True/false?

Answer 18

True

Question 19

What are the approximate success rates for IVF?

Answer 19

35%

Question 20

What are the two primitive genital tracts?

Answer 20

Wolffian

Mullerian

Question 21

Which primitive genital tract leads to the development of the male internal genital tract?

Answer 21

Wolffian

Question 22

Which hormone is responsible for the differentiation of external genitalia?

Answer 22

Dihydrotestosterone

Question 23

What occurs in androgen insensitivity syndrome?

Answer 23

Patients have a male karyotype but are phenotypically female

Question 24

Why it is important for the testes to descend?

Answer 24

As the lower temperature outside the body facilitates spermatogenesis

Question 25

What is cryptorchidism?

Answer 25

Failure of testes descent

Question 26

Which cells are responsible for the production of testosterone?

Answer 26

Leydig cells

Question 27

Give some functions of the Sertoli cells

Answer 27

Form blood-testes barrier Nutrition Phagocytosis Seminiferous tubule fluid secretion

Question 28

Which pituitary hormone regulates testosterone secretion?

Answer 28

LH

Question 29

Which pituitary hormone enhances spermatogenesis?

Answer 29

FSH

Question 30

Give some of the effects of testosterone

Answer 30

Pubertal characteristics Spermatogenesis Secondary sexual characteristics

Question 31

What is male infertility?

Answer 31

Failure of the sperm to normally fertilise the egg

Question 32

Give some obstructive causes of male infertiltiy

Answer 32

Cystic fibrosis Vasectomy Infection (chlamydia)

Question 33

Give some non-obstructive causes of male infertility

Answer 33

Cryptorchidism Mumps Testicular tumour Chemotherapy

Question 34

Give some endocrine causes of male infertility

Answer 34

``` Pituitary tumours (prolactinoma) Kallman's syndrome (no GnRH) Thyroid disorders Diabetes Congenital adrenal hyperplasia ```

Question 35

What is the normal testicular volume in men?

Answer 35

12-25 ml

Question 36

Give some factors which may affect semen analysis

Answer 36

Period of abstinence Condition during transport Health of donor

Question 37

Give some clinical features of obstructive male infertility

Answer 37

Normal testicular volume Normal secondary sexual characteristics Absent vas deferens Normal LH/FSH/testosterone

Question 38

Give some clinical features of non-obstructive male infertility

Answer 38

Low testicular volume Reduced secondary sexual characteristics Present vas deferens High LH/FSH

Question 39

What is the main treatment for main infertility?

Answer 39

Intracytoplasmic sperm injection

Question 40

What is involved in ICSI?

Answer 40

Sperm prepared from semen | Sperm injected into egg

Question 41

What is involved in surgical sperm aspiration?

Answer 41

Needle inserted into epididymis and sperm aspirated