Subfertility Flashcards
(85 cards)
What is a natural cycle IVF?
It is an IVF procedure in which one or more oocytes or collected from ovaries during spontaneous menstrual cycle without the use of drugs
Definition of mild male factor infertility
It is when two samples of semen analysis have at least one variable that is below the fifth percentile
What are the indication for early referral to an infertility specialist?
Women’s age: more than 36 years
If that is a known clinical cause of infertility or a history of predisposing factors for infertility
When should investigation be performed for a patient undergoing artificial insemination?
If she fails to conceive within six cycles of treatment
When is male sub fertility is considered severe?
If on two different occasions we have one severely abnormal value or 2 mild abnormalities
When is investigated needed when dealing with subfertility?
Investigation is needed after one year of unprotected sexual intercourse and patients below 36 years of age or if 6 cycles of artificial insemination were not successful or if the patient is higher risk, meaning she’s above 36 years of age (then we investigate after 6 months) or if she has cancer and needs intervention then investigation and evaluation should be performed as early as possible
After investigating a risk couple after one year of unprotected sexual intercourse with no pregnancy. If the investigation turned out negative, what would be the next step?
In this situation, expected management for another year is warranted then investigations are repeated if they are still normal then IVF is indicated
For high risk patients after 6 months of unprotected sexual intercourse with no pregnancy, investigation is indicated. How should we proceed if the investigations turned out to be normal?
A 6-months expectant management should be performed followed by another set of investigation, if the investigation are still normal then IVF is needed
What is the chance for a woman under 40 years of age to conceive using IUI after 6 cycles and after 12 cycles?
50%
75%
What is the chance of couples in the general population to conceive within one year or 2 years if the woman is aged less than 40 years and they have regular sexual intercourse?
80%
90%
What is the effect of smoking on male and female fertility?
Both male and female fertility can be decreased due to smoking even if passive
Semen quality was reduced among smokers
What is the advice to give for couples who are trying to conceive regarding alcohol intake?
Woman are allowed to consume 1 to 2 units of alcohol per week
Men are advice to consume less than three to four per day
When should we investigate a woman with signs of PCOS and 2 month history of infertility?
Immediately.
Every time we have a calls for infertility investigation should not be delayed. It respective of the time to get pregnant.
Relationship between caffeine intake and infertility
No consistent data linking fertility to caffeine intake
Male infertility and tied underwear
Tight underwears are associated with increased scrotal temperature and reduce semen quality
Relationship between BMI and infertility
For patients with BMI more than 30 and not ovulating, losing weight is likely to increase the chances of conception
Men with BMI more than 30 are likely to have reduced fertility
For women with a BMI of less than 19 and irregular or no menstruation, increasing their body weight is likely to improve their chance of conception
What are the terminology used to describe a semen analysis?
What is the recommended dose of folic acid to take before pregnancy and for how long?
For low risk patients it is recommended to take a dose of 0.4 mg per day for 12 weeks before gestation and for 12 weeks after
The patients that are considered high risk are the ones with a BMI more than 30, diabetes mellitus, thalassemia, sickle cell disease, history of neural tube defect (maternal or paternal) Celiac disease sulfasalazine intake
These high risk patients are required to take 5 mg per day
And the ones with structured problems are required to take folic acid throughout pregnancy, not just for 12 weeks
What are the semen analysis parameters as per the WHO?
Cement volume more than 1.5
pH more than 7.2
Total sperm count more than 39 millions per ejaculation
Sperm concentration more than 15 million per ml
Total motility more than 40% progressive motility more than 32%
Normal morphology more than 4%
Which of the following investigations is it required to predict outcome of fertility treatment?
Ovarian volume
Ovarian blood flow
Inhibin B
Estradiol E2
How can AFC predict low and high response?
If less than 4: low response
If more than 16: response
How can AMH predict IVF treatment response?
AMH less than 5.4 low response
AMH more than 25 high response
How can FSH predict IVF treatment response?
FSH more than 8.9: low response
FSH less than 4: high response
What is the first test to do in the investigation of infertility?
Simen analysis
If mildly normal repeat in 3 months
If severely abnormal: Repeat as soon as possible
