Infertility

Question 1

What is the definition of Infertility?

Answer 1

Failure to achieve pregnancy after 12 months or more of regular, unprotected intercourse

Question 2

After what period of time should you evaluate a 35 yr old with infertility?

Answer 2

after 6 months

Question 3

What percentage of couples in the US are affected by infertility?

Answer 3

15%

Question 4

What is the approximate pregnancy rate (fecundability) for a normal couple?

Answer 4

25%

Question 5

What percent of infertility can be attributed to male factor?

Answer 5

10 %

Question 6

What percent of infertility can be attributed to Tubal or pelvic pathology?

Answer 6

35%

Question 7

What percent of infertility can be attributed to ovulatory dysfunction?

Answer 7

15%

Question 8

What percent of infertility is unexplained?

Answer 8

35%

Question 9

What method of imaging should be used in patients with infertility likely secondary to tubal disease?

Answer 9

Hysterosalpingogram

Question 10

What method of imaging should be used to assess for intracavitary causes of infertility?

Answer 10

Sonohysterogram

Question 11

What is the rate of infection following hysterosalpingogram?

Answer 11

1.4 - 3.4%

Question 12

If HSG demonstrates dilated fallopian tubes, what is the next best step in management?

Answer 12

Doxycycline 100 mg BID for 5 days

Question 13

What test should you order to determine if ovulation has occurred and on what day of the menstrual cycle?

Answer 13

serum progesterone, day 20

Question 14

What value of serum progesterone indicates ovulation has occured?

Answer 14

> 3 ng/ml

Question 15

Ovarian reserve can be estimated by what 3 tests?

Answer 15

Cycle day 3 FSH, AMH, Antral follicle count

Question 16

What level of cycle day 3 FSH indicates diminished ovarian reserve?

Answer 16

> 10 - 12

Question 17

What antral follicle count indicates diminished ovarian reserve?

Answer 17

< 5 follicles in both ovaries

Question 18

What level of AMH indicates diminished ovarian reserve?

Answer 18

< 0.7ng/ml

Question 19

Endometriosis is found in what percentage of infertile women?

Answer 19

30 - 40%

Question 20

What percent of reproductive age women have endometriosis?

Answer 20

5- 10%

Question 21

Semen analysis: Normal Volume?

Answer 21

1.0 ml or more

Question 22

Semen analysis: normal concentration?

Answer 22

15 million/ml or more

Question 23

Semen Analysis: Normal Motility/progression?

Answer 23

40% or more with forward progression

Question 24

Semen Analysis: Morphology?

Answer 24

> 4% with normal morphology

Question 25

How long does spermatogenesis take?

Answer 25

3 months

Question 26

What type of medication is Letrozole?

Answer 26

Aromatase inhibitor

Question 27

What is the mechanism of action of Letrozole?

Answer 27

Inhibits production of Estrogen, thereby decreasing the negative feedback and increasing release of GnRH

Question 28

What is the starting dose of Letrozole?

Answer 28

2.5 mg/day

Question 29

On what cycle day should you start taking letrozole?

Answer 29

Cycle day 3

Question 30

What is the max dose of letrozole that you can use?

Answer 30

7.5 mg daily

Question 31

What type of medication is Clomiphene Citrate?

Answer 31

selective estrogen receptor modulator (SERM)

Question 32

What is the mechanism of Clomphine Citrate?

Answer 32

blocks negative feedback of estrogen and increases gonadotropin secretion

Question 33

What is the starting dose of clomiphene citrate?

Answer 33

50 mg

Question 34

On what cycle day should you start taking clomid?

Answer 34

Cycle day 3

Question 35

For how many days do you take clomid?

Answer 35

5 days

Question 36

What is the max dose of clomid that you can use?

Answer 36

200 - 250 mg

Question 37

What is the risk of multiple gestation when using clomid or letrozole?

Answer 37

10%

Question 38

up to how many hours after ovulation can an egg be fertilized?

Answer 38

12 - 24 hrs

Question 39

When do you use gonadotropins for ovulation induction?

Answer 39

Generally in IVF treatments for hyperstimulation

Question 40

What is the national clinical pregnancy rate for IVF?

Answer 40

35%

Question 41

in what percent of IVF cycles does ovarian hyper stimulation occur?

Answer 41

10%