PBL1 - Subfertility

Question 1

Primary sub fertility

Answer 1

No previous pregnancy

Question 2

Secondary sub fertility

Answer 2

Previous pregnancy, whatever the outcome

Question 3

Sub fertility incidence

Answer 3

15%

Question 4

Female factors of subfertility (4)

Answer 4

Ovulation disorders
Tubal damage
Endometriosis
Cervical mucous hostility

Question 5

Male factors for subfertility (1)

Answer 5

Disorders of sperm production or transport

Question 6

Coital problems leading to subfertility:

Answer 6

Impotence
Dyspareunia (pain in sex)
Coital frequency of less than 3 times per week

Question 7

Infertility - check men for …

Answer 7

Mumps orchitis

Question 8

Physical examination of female look for (3)

Answer 8

Hirsutism
Pelvic tumour e.g. Fibroids, ovarian cysts
Genital abnormalities e.g. Rigid hymen, vaginal atresia

Question 9

Physical examination of male look for (3)

Answer 9

Lack of virilisation
Small testicular size
Epididymal cysts
Varicoceles

Question 10

Semen analysis:
Volume ...
.... million/ml density
... motility
Repeat tests .... Times, after each months interval

Answer 10

Volume 2-5ml
>15 million/ml density
>40% motility
Repeat tests 3 times, after each months interval

Question 11

Ovulation tests:

3

Answer 11

Biphasic basal body temperature chart
Luteal phase plasma progesterone level - >30nmol/ml
Pulsatile LH secretion - peaks 36 hours before ovulation

Question 12

Ovum survives for

Answer 12

24 hours

Question 13

Sperms remains fertile for

Answer 13

72 hours

Question 14

Assess tubal patency and pelvic assessed by… (2)

Answer 14

Ultrasound

Hysterosalpinography (X-ray and dye)

Question 15

Postcoital tests / Kremer tests check for …

Aspirated when?

Answer 15

Cervical hostility - happens mid cycle

Cervical mucus is aspirated 12 hours after intercourse and checked for sperm numbers and motility

Question 16

Oligomennorrhea

Answer 16

Irregular periods

Question 17

Most common cause of anovulatory infertility

Answer 17

PCOS

Question 18

PCOS cause (2)

Answer 18

Insulin resistance, leads to hyperinsulinaemia

Stimulate androgen production by theca cells in ovary

Question 19

Diagnostic criteria PCOS:

4

Answer 19

Infrequent / Absent ovulation
Hyperandrogenism (excessive hair, acne, raised LH and androgens)
Polycystic ovarian morphology on ultrasound - >12 follicles between 2-9mm in diameter, ovarian volume >10ml

Question 20

PCOS treatment: (3)

Answer 20

Weight loss
Ovulation induction by clomiphene
Wedge resection (surgery)
The pill
Anti-androgens e.g. Cryproterone acetate 
Metformin

Question 21

Induce ovulation with

Answer 21

Clomiphene

Question 22

Anti-androgen -

Answer 22

Cyproterone acetate

Question 23

Pelvic inflammatory disease - 2 main std’s

Answer 23

Chlamydia trachomatis

Neisseria gonorrhoeae

Question 24

PID leads to …

Answer 24

Scarring of ovaries and oviducts

Leads to narrowing / complete closure - infertility

Question 25

Before subfertility treatment check for

Answer 25

Rubella

Question 26

Treatment of ovulation failure (2)

Answer 26

Oral clomiphene citrate | Human menopausal gonadotrophins - injected daily

Question 27

Why must you monitor ovulatory treatment (2)

Answer 27

Reduce the risk of multiple pregnancy | Stop ovarian hyperstimulation syndrome

Question 28

Pregnancy rates per cycle for women under 40 are

Answer 28

25-30%

Question 29

Four cycles IVF success rates

Answer 29

60%

Question 30

Male infertility treatments

Answer 30

``` Intrauterine insemination (IUI) Intracytoplasmic sperm injection (ICSI) ```

Question 31

Use IVF / IUI / ICSI after .... Of subfertility

Answer 31

2 years

Question 32

Subfertility

Answer 32

Defines as the inability to conceive for 12 months after regular unprotected regular intercourse