Subfertility

Question 1

Subfertility?

Answer 1

Delayed conception after 12 months of regular unprotected sex

Question 2

Causes of subfertility

Answer 2

Female (ovarian, uterine and tubal)
Male causes

Question 3

Ovarian causes

Answer 3

PCOS
Hyperprolactinemia
Endocrine problem

Question 4

Uterine causes

Answer 4

Intramural and submucosal fibroids
Ashermann syndrome
Polyp

Question 5

Tubal disorders?

Answer 5

PID
Endometriosis
Hydrosalpinx

Question 6

__________ fibroids dont cause subfertility

Answer 6

Subserosal

Question 7

Male causes

Answer 7

Stress, ED, smoking, age, cancer, diabetes, mumps, epididymitis, previous surgery

Question 8

SFA

Answer 8

Semen fluid analysis

Question 9

Investigation

Answer 9

CBC
LFT
UCE
TFT
FSH
LH
Prolactin
AMH
AFC
HBA1C
Testosterone
TVUS
Hysterosalpingography

Question 10

Male investigation

Answer 10

SFA (repeat it after 3 months)
Baseline
Karyotyping
Total Motile Count
Sperm count

Question 11

Abstinence from intercourse for ______ before SFA

Answer 11

2-4 days

Question 12

Treatment

Answer 12

Clomiphene citrate
Metformin
IVF
Adoption
Ovarian drilling
Intrauterine insemination

Question 13

Fecundability

Answer 13

Likelihood of conceiving within one menstrual cycle

Question 14

% of fecundability

Answer 14

18-20% in a young healthy couple
70% within 6 months
80% within 12 months
90% within 24 months

Question 15

Single most important factor for subfertility

Answer 15

Female age

Question 16

A person with subfertility also has symptoms of visual field defects

Answer 16

Prolactinoma

Question 17

A person with subfertility also has symptoms of acne, hair growth

Answer 17

PCOS (hyperandrogenism)

Question 18

If a person has regular cycle then we will investigate for

Answer 18

FSH
LH
AMH

Question 19

If a person has irregular cycles then we will investigate for

Answer 19

TFT
Prolactin
Testosterone

Question 20

Infection screening for subfertility

Answer 20

Chlamydia
HIV
Hep B and C

Question 21

Progesterone is tested on the ______________ day to confirm ovulation

Answer 21

21th day of the cycle or mid-luteal phase

Question 22

AMH is used to check _____________

Answer 22

ovarian reserve

Question 23

__________ is the best biomarker of ovarian reserve

Answer 23

AMH

Question 24

AFC >16 is _________ response

Answer 24

high

Question 25

AFC <4 is ___________ response

Answer 25

low

Question 26

Complication of using clomiphene citrate

Answer 26

Multiple pregnancies

Question 27

Laparoscopic ovarian drilling is used only when there is _______________

Answer 27

no response to clomiphene citrate

Question 28

Tx of hypothalamic disorder

Answer 28

injectable pulsatile gonadotrophins

Question 29

Tx of hyperprolactinemia

Answer 29

Surgery Dopamine agonist

Question 30

What tests are used for tubal patency?

Answer 30

Hysterosalpingogram Hysterocontrastsynography Laparoscopy and Dye Insufflation

Question 31

Hysterosalpingogram is performed during ____________

Answer 31

follicular phase Exposed to Xrays

Question 32

Hysterocontrastsynography uses _____________

Answer 32

ultrasound

Question 33

_________________ is gold standard for tubal patency assessment

Answer 33

Laparoscopy

Question 34

Explain the procedure of laparoscopy and dye insufflation

Answer 34

Pneumoperitoneum is created Methylene blue is injected into uterine cavity. Normal = When the dye distends the tube and spills out into the abdominal cavity Abnormal = When the dye doesn't enter either tube

Question 35

Tx of adhesion

Answer 35

laparoscopic adhesiolysis

Question 36

Tx of blocked tube

Answer 36

tubal surgery

Question 37

Tx of endometriosis (surgical)

Answer 37

laparoscopic ablation

Question 38

Tx of fibroid

Answer 38

Myomectomy Hysteroscopy Embolization

Question 39

Oligozoospermia means

Answer 39

Sperm conc less than 15 million/ml or less than 39 million per ejaculate

Question 40

Asthenozoospermia means

Answer 40

Sperm motility less than 32%

Question 41

Teratozoospermia means

Answer 41

Sperm morphology less than 4%

Question 42

Azoospermia mean

Answer 42

No sperms in ejaculate

Question 43

Aspermia mean

Answer 43

no ejaculate

Question 44

What is oligoasthenoteratozoospermia?

Answer 44

Low concentration Low motility Poor morphology

Question 45

pH of semen

Answer 45

more than 7.2

Question 46

Vitality of sperm

Answer 46

58%

Question 47

What are the antispermatogenic drugs?

Answer 47

Alcohol Anabolic steroid

Question 48

What are antiandrogenic drugs?

Answer 48

Cimetidine Spironolactone

Question 49

What drugs cause ejaculatory dysfunction?

Answer 49

alpha and beta blockers Antidepressants

Question 50

Tx of Retrograde ejaculation

Answer 50

Sympathomimetics

Question 51

Abnormal SFA then perform

Answer 51

FSH LH Testosterone