NICE Fertility problems: assessment and treatment

Question 1

What is the minimum reference value for semen volume according to WHO?

Answer 1

1.5 ml or more.

Question 2

What is the normal pH level of semen based on WHO reference values?

Answer 2

7.2 or more.

Question 3

What is the minimum normal sperm concentration per ml?

Answer 3

15 million spermatozoa per ml or more.

Question 4

What is the reference value for total sperm number per ejaculate?

Answer 4

39 million spermatozoa per ejaculate or more.

Question 5

What is the reference value for total motility in semen analysis?

Answer 5

40% or more motile OR 32% or more with progressive motility.

Question 6

What is the minimum percentage of live spermatozoa (vitality) according to WHO?

Answer 6

58% or more.

Question 7

What is the WHO reference value for sperm morphology (normal forms)?

Answer 7

4% or more normal forms.

Question 8

What does a low semen volume suggest clinically?

Answer 8

Possible retrograde ejaculation, obstruction, or seminal vesicle dysfunction.

Question 9

Why is it important to repeat a semen analysis if the first test is abnormal?

Answer 9

Because semen quality can fluctuate; confirmation is needed.

Question 10

After how long should a repeat semen analysis ideally be performed if the first is abnormal?

Answer 10

3 months after the initial test.

Question 11

Why should repeat semen analysis be delayed for 3 months after the first test?

Answer 11

To allow a full cycle of spermatogenesis (~74 days) to complete.

Question 12

When should a repeat semen analysis be done sooner than 3 months?

Answer 12

If azoospermia or severe oligozoospermia is detected.

Question 13

What is azoospermia?

Answer 13

Complete absence of sperm in the ejaculate.

Question 14

What is severe oligozoospermia?

Answer 14

Very low sperm concentration, typically <5 million/ml.

Question 15

Should screening for antisperm antibodies be offered routinely?

Answer 15

No, because there is no effective treatment to improve fertility.

Question 16

What do antisperm antibodies do?

Answer 16

They impair sperm motility and fertilisation capacity.

Question 17

What is the main purpose of semen analysis in fertility assessment?

Answer 17

To evaluate sperm quality and detect male factor infertility.

Question 18

Can men with abnormal semen parameters still achieve natural pregnancy?

Answer 18

Yes, many men below reference ranges can still be fertile.

Question 19

What is the best initial predictor of a woman’s fertility and IVF success?

Answer 19

A woman’s age.

Question 20

What does Antral Follicle Count (AFC) measure?

Answer 20

The number of small (2–10 mm) follicles seen on transvaginal ultrasound, typically on day 3 of the cycle.

Question 21

What AFC value suggests a low response to IVF stimulation?

Answer 21

An AFC of 4 or fewer.

Question 22

What AFC value suggests a high response to IVF stimulation?

Answer 22

An AFC greater than 16.

Question 23

What hormone is produced by ovarian follicles and used to assess ovarian reserve?

Answer 23

Anti-Müllerian Hormone (AMH).

Question 24

What AMH value suggests a low response to IVF stimulation?

Answer 24

AMH ≤ 5.4 pmol/L.

Question 25

What AMH value suggests a high response to IVF stimulation?

Answer 25

AMH ≥ 25.0 pmol/L.

Question 26

On which day of the menstrual cycle should FSH be measured for ovarian reserve testing?

Answer 26

Day 3 of the menstrual cycle.

Question 27

What FSH level suggests a low ovarian reserve (poor response)?

Answer 27

FSH > 8.9 IU/L.

Question 28

What FSH level suggests a likely good ovarian response?

Answer 28

FSH < 4 IU/L.

Question 29

Should AMH be measured on a specific day of the cycle?

Answer 29

No — AMH can be measured at any point in the menstrual cycle.

Question 30

Name three tests that should NOT be used individually to predict fertility treatment outcome.

Answer 30

Ovarian volume, ovarian blood flow, inhibin B, and oestradiol (E2).

Question 31

Why is age a crucial factor in fertility assessment?

Answer 31

Because both egg quantity and quality decline significantly with age.

Question 32

What is the purpose of ovarian reserve testing in the context of IVF?

Answer 32

To predict the likely ovarian response to gonadotrophin stimulation for IVF.

Question 33

What is the risk of a very high ovarian response in IVF (e.g., >20 oocytes)?

Answer 33

Ovarian hyperstimulation syndrome (OHSS) and cycle complications.

Question 34

Why is serum progesterone measured in women undergoing infertility investigations?

Answer 34

To confirm whether or not ovulation is occurring.

Question 35

What does a high serum progesterone level in the luteal phase indicate?

Answer 35

That ovulation has occurred — the corpus luteum is producing progesterone.

Question 36

When should serum progesterone be measured in a 28-day cycle?

Answer 36

On day 21 of the cycle.

Question 37

Why is day 21 chosen for serum progesterone testing in regular cycles?

Answer 37

Because ovulation usually occurs around day 14, and progesterone peaks about 7 days after ovulation.

Question 38

Can regular menstrual cycles confirm ovulation without testing?

Answer 38

No — ovulation should still be confirmed with serum progesterone testing.

Question 39

What should be done if a woman has irregular or long menstrual cycles?

Answer 39

Time the test based on estimated ovulation or repeat weekly until menstruation.

Question 40

In a 35-day cycle, on which day should serum progesterone be tested?

Answer 40

On day 28 of the cycle.

Question 41

How often should serum progesterone be tested in irregular cycles if ovulation timing is unclear?

Answer 41

Weekly until the next period starts.

Question 42

What serum progesterone level strongly suggests ovulation?

Answer 42

Greater than 30 nmol/L.

Question 43

What serum progesterone level suggests possible ovulation?

Answer 43

Between 16–30 nmol/L.

Question 44

What serum progesterone level suggests anovulation?

Answer 44

Less than 16 nmol/L.

Question 45

Why is it inappropriate to test on day 21 in women with irregular cycles?

Answer 45

Because day 21 may fall before ovulation and give a false low result.

Question 46

What is the typical timing of ovulation in a 28-day menstrual cycle?

Answer 46

Around day 14.

Question 47

What is the role of the corpus luteum in progesterone production?

Answer 47

It secretes progesterone after ovulation during the luteal phase.