Repro 1

Question 1

how can you define female infertility

Answer 1

12 months of unprotected sex and no baby

Question 2

how can female causes on infertility be divided up

Answer 2

ovulating?
sperm?
pathway?

Question 3

tests that can be done to assess ovulation

Answer 3

day 21 progesterone test

>30 is normla

Question 4

other tests to assess infertility

Answer 4

sperm analysis

chlamydia. rubella. Hep B/C. HIV. ovarian reserve. pituitary hormones. testosterone

Question 5

who is allowed to have IVF

Answer 5

<40 or 12 cycles of artificial insemination
40-42 12 cycles and no previous IVF, no evidence of low ovarian reserve and risks discussed
pelvic disease, anovulatory disease, genetic disease etc

Question 6

what needs to happen before IVF treatment

Answer 6

alcohol <4 units per week. no smoking. weight BMI 19-29. folic acid 4g per day. smear. rubella. HIV. Hep B/C. chlamydia

Question 7

IVF steps - just main ones 8

Answer 7

down regulation 
baseline scan 
ovarian stimulation 
action scan 
sperm sample 
oocyte collection 
embryologist 
transfer

Question 8

what happens during down regulation what is given and why

SE of whatever is given

Answer 8

buserlin - synthetic GnRH agonist as nasal spray/injection
to reduce cancellation from ovulation and impose success rate and to allow precise timing of oocyte recover by using HCG trigger
headaches, hot flushes, mood swings, nasal irritation

Question 9

what happens during ovarian stimulation

SE

Answer 9

GnRH and FSH plus or LH given as daily S/C injection for 10-14 days to allow follicular development
mild allergic reaction. OHSS

Question 10

what happens during the action scan - what if theres a slow response
what should be assessed for
what if normal

Answer 10

if slow response (40-50%) repeat scan 72 h
if poor response to FSH - increase dose
assess for OHSS
plan date/time for HCG injection

Question 11

what should be done for the sperm sample and what is assessed

Answer 11

abstinence for 72 hours

motility, progression, volume, density

Question 12

what bad things can happen during oocyte collection

what is it described as

Answer 12

bleeding, pelvic infection, failure to obtain

like a smear

Question 13

embryologist dos what

Answer 13

finds eggs and incubates at 37 degrees

Question 14

when does transfer occur

Answer 14

at d5 when its a blastocysts

Question 15

what is given to patient and done after transfer

Answer 15

progesterone supplements (cyclogest) for 2 weeks and a UPT

Question 16

what are the symptoms of OHHS

Answer 16

abdominal pain. ascites. N/V. ARDS. thromboembolism/ tense ascites

Question 17

what is the treatment of OHSS

Answer 17

analgesia/ anti emetic. paracentesis. fluid balance. LMWH. admit.

Question 18

when should IUI be done

Answer 18

unexplained infertility. mild/mod endom. mild male factor infertility

Question 19

what happens during IUI

Answer 19

in natural/stimulated cycle prepared semen inserted at time of ovulation to increase the number of sperm that reach the fallopian tubes

Question 20

what is ICSI done

Answer 20

failed IVF. severe male factory infertility. pre implantation genetic disease

Question 21

how is ICSI done

Answer 21

extract from epididymis if obstructive, testicular tissue if not. egg stripped (obtained via IVF). sperm immobilised and injected. incubate at 37 degrees

Question 22

success created for IUI

ICSI

Answer 22

10% per cycle

30% per cycle

Question 23

causes of male infertility (3)

Answer 23

idiopathic. obstructive. non-obstructive

Question 24

obstructive causes

Answer 24

CF, vasectomy, infection

Question 25

non obstructive causes

Answer 25

cryptochordism, mumps, orchiditis, chemo/radio, tumour, klinefelters, semen abnomarlities, systemic, endocrine

Question 26

normal testicular volume in pre pubertal pubertal abnormal

Answer 26

1-3mls 12-25 <5

Question 27

what is done on semen analysis

Answer 27

volume, density, morphology, progression

Question 28

if semen analysis is positive why should it be done again nd when

Answer 28

3 months later: health, completeness of sample, period of abstinence, condition and time between transport, production and assessment, natural variation between samples

Question 29

results of investigations done on obstructive

Answer 29

normal testicular volume and normal secondary sexual characteristics normal LH/FSH/testosterone VD may be missing

Question 30

NO examination results

Answer 30

abnormal testicular volume (low) and decreased secondary sexual characteristics, VD present, increased FSH/LH, decreased testosterone

Question 31

treatment of male infertility

Answer 31

frequent sex, alcohol <4 units per week, no smoking/caffiene, avoid tight baths, hot baths/saunas, avoid tight fitting pants, anti oxidants (vitc/zinc), IUI, ICSI, aspiration, donor insem

Question 32

when is sperm aspiration done and success rates and what is done after

Answer 32

azoospermina surgically NO 50% and 95% in obstructive ICSI

Question 33

donor insemination success rate

Answer 33

15% per cycle

Question 34

what is cryptochordism and how does it affect fertility

Answer 34

undescended testes | reduces sperm count but if unilateral still fertile

Question 35

treatment for cryptochordism

Answer 35

orchidopexy in <1s to reduce risk of cancer | orchidotomy in adults

Question 36

androgen insensitivity syndrome geentics

Answer 36

congenital insensitivity to androgens AR 46XY

Question 37

pathology of androgen insensitivity syndrome

Answer 37

androgen induction of wolffian duct does not occur but mullerian inhibition does

Question 38

symptoms and signs of androgen insensitivity syndrome

Answer 38

``` born phenotypically female - absence of uterus and ovaries and short vagina primary amen lack of pubic hair breast development undescended testis ```

Question 39

test for androgen insensitivity syndrome

Answer 39

buccal smear - chromosome analysis

Question 40

treatment for androgen insensitivity syndrome

Answer 40

counselling - raise kid as girl orchidectomy oestrogen therapy

Question 41

klinefelters syndrome geneticd

Answer 41

47XXY

Question 42

clinical presentation of kilnefelterrs

Answer 42

tall, lack pf pubic hear, gynacamastia, infertility, decreased facial and body hair, small and firm testes, increased FSH and LH

Question 43

ix for klinefelters | rx

Answer 43

chromosome analysis | testosterone therapy

Question 44

tubal infertility causes investigations treatment

Answer 44

chlamydia. PID. anatomical if history of PID - laparoscopy and dye hydrotubation HSG. if bilateral tubal dx- IVF