Week 7 - Conception and Contraception

Question 1

What is the most common cause of male infertility?

Answer 1

Abnormal semen analysis - abnormalities of number, morphology or motility of sperm in semen analysis

Question 2

Most common cause of female infertility?

Answer 2

Anovulation

Question 3

Most common cause of unpredictable, irregular upper genital tract bleeding?

Answer 3

Anovulation

Question 4

State some causes of secondary anovulation?

Answer 4

1. Polycystic ovarian syndrome
2. Hyperprolactinemia
3. Pregnancy
4. Emotional stress

Question 5

State some causes of primary anovulation.

Answer 5

1. Dysgenetic gonads
2. Hypothalamic dysfunction
3. Hypothyroidism

Question 6

What is Kallman syndrome caused by?

Answer 6

Defect in development of GnRH neurons and olfactory bulb

Question 7

What process is responsible for the production of acellular mucus with low viscosity and high stretchibility?

Answer 7

Oestrogen action on cervical glands

Question 8

Which kind of mucus does oestrogen stimulate production of?

Answer 8

In the follicular phase, prior to ovulation, oestrogen stimulates production of thin watery mucus which promotes sperm transport

Question 9

What kind of mucus does progesterone stimulate production of?

Answer 9

Progesterone stimulates thickening of cervical mucus in the luteal phase, thus inhibiting sperm transport

Question 10

What is spermiation?

Answer 10

Release of spermatozoa from Sertoli cells into lumen of seminiferous tubules

Question 11

What is the primary mechanism of action of the progesterone depot/implant?

Answer 11

Prevention of ovulation

Question 12

What is the primary mechanism of action of the combined oral contraceptive pill?

Answer 12

Prevention of ovulation - mimics the luteal phase of the ovarian cycle, thus suppressing the HPO axis

Question 13

What are the commonest causes of erectile dysfunction in men?

Answer 13

1. Psychological
2. Endocrine, e.g. diabetes
3. Neurological
4. Alcohol

Question 14

What clinical sign may indicate a diagnosis of hyperprolactinaemia?

Answer 14

Production of small quantities of milk

Question 15

What drug could be used to treat hyperprolactinaemia and how does it work?

Answer 15

Bromocriptine - dopamine agonist: mimics the effects of prolactin inhibitory hormone

Question 16

How in practice might you test whether uterine tubes are patent?

Answer 16

• Passage of radio-opaque dye from the uterine cavity

- Hysterosalpingography

Question 17

How in principle would you set about inducing ovulation in a woman whose cycles are anovulatory - which drug would you use and why?

Answer 17

1. Use an anti-oestrogen to reduce inhibition of FSH and LH

2. Clomiphene given for a few days prior to expected time of ovulation

Question 18

What are the long-term risks of polycystic ovarian syndrome?

Answer 18

1. Endometrial malignancy - abnormal estrogen secretion

2. Increased risk of diabetes and cardiovascular disease - insulin resistance

Question 19

What is the clinical presentation of polycystic ovarian syndrome?

Answer 19

1. Secondary amenorrhoea/infertility
2. Hirsutism
3. Obesity

Question 20

What features of excess androgens may be present in PCOS?

Answer 20

1. Hirsutism: which may be blocked by anti-androgen therapy

2. Oily skin/acne