Infertility & Assisted Conception

Question 1

what are the 4 different types of defining gender

Answer 1

• Chromosomal sex: presence/absence of Y chromosome
• Gonadal sex: foetus with ovaries or testes
• Genital sex: male or female external genitalia
• Gender: female or male identity – perceived genital sex and rearing as female or male

Question 2

how muchb of fertility are male factors causing

Answer 2

around a third

Question 3

is male infertility increasing or decreasing

Answer 3

increasing

Question 4

what is the most common cause of male infertility

Answer 4

idiopathic

Question 5

what is normal testicular volume in adults and pre pubertal

Answer 5

12-15ml adult

1-3ml pre pubertal

Question 6

what investigations are performed in male infertility

Answer 6

• semen analysis
• endocfrine profile
• chromosome analysis
• CF screening
• testicular biopsy/scrotal US

Question 7

what is examined on semen analysis

Answer 7

volume, density, motility, progression and morphology

Question 8

what 6 things can affect semen sample

Answer 8

1. completeness of sample
2. period of abstinence (>3 days)
3. condition during transport (temperature)
4. time between product and assessment
5. natural variation between samples
6. health of man 3 months before production

Question 9

how many times is semen analysis performed

Answer 9

twice - 6 weeks later

Question 10

describe the picture seen on examination w/ obstructive infertility

Answer 10

• Normal sperm production, mechanical blockage
• Normal testicular volume and secondary sexual characteristics
• The vas deferens may be absent
• Endocrine: normal LH, FSH and testosterone

Question 11

describe the picture seen with non-obstructive male infertility

Answer 11

• Sperm production deficient/absent
• Low testicular volume and reduced secondary sexual characteristics
• Endocrine: high LH, FSH ± low testosterone

Question 12

male infertility: how often do you advise sex

Answer 12

2-3 times a week

Question 13

male infertility: alcohol, smoking and caffiene advice

Answer 13

alcohol <4 units a day

stop smoking - decreased semen quality and general health

no caffeine evidence

Question 14

does BMI effect sperm

Answer 14

BMI <18.5/>30 is associated with decreased fertility and taking >1 year to get pregnant

also, insulin resistance PCOS etc

Question 15

what are teh reversal rates for vasectomy

Answer 15

75% within 3 years, 55% 3-8years

Question 16

what are teh success rates of IVF and ICSI

Answer 16

35%

Question 17

how can pregnancy be achieved if man has azoospermia

Answer 17

donor sperm insemination

adoption etc

Question 18

what investigations are done inthe female presenting with infertility

Answer 18

• lifestyle - drugs, alcohol, weight, smoking
• folic acid - 400mcg pre conception (5mg if obese/DM/epilepsy etc)
• check rubella immune
• cervical smears upt o date
• STI check
• screen for blood borne viruses eg hep and hiv

Question 19

what investigation can be done in a female to investigate her fertility potential

Answer 19

antral follicle count - by transvaginal US

Question 20

how can tubal patency be tested

Answer 20

hysterosalpinogram (X ray) and laparoscopy with dye

Question 21

what is IUI

Answer 21

preapred semen inserted into uterine cavity around the time of ovulation

Question 22

what are the main indications for IUI

Answer 22

• sexual problems, same sex relationships, discordant BBV or abandoned IVF

Question 23

after how many years of unexplained infertility can you get IVF

Answer 23

>2years

Question 24

at what stage is the embryo transfered into the uterus in IVF

Answer 24

blastocyst stage