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Gynaecology > Management of Infertility > Flashcards

Flashcards in Management of Infertility Deck (93)
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1

What is the first step to managing a couple with infertility?

Support and reassurance

2

Why is support important in infertility?

Can be a very difficult time with external pressure and internal emotions

3

Do most cases of infertility require intervention?

No

4

Why is continuous reassurance important in infertility?

Couples often conceive whilst being investigated and stress can impact relationship

5

What external support may be helpful for couples with infertility?

- Support groups
- Counselling

6

What general advice can be given to couples with fertility problems?

- Folic acid
- Frequency of sexual intercourse
- Alcohol
- Smoking
- Weight

7

What information should women with fertility issues be told regarding folic acid?

They should take 0.4mg/day before conception and up to 12 weeks gestation

8

Why is folic acid supplementation advised?

To reduce the risk of neural tube defects

9

What frequency of sexual intercourse optimises chances of conception?

Every 2-3 days

10

How can alcohol affect fertility in men?

Can affect semen quality

11

How can alcohol affect fertility in woman?

Advised not to when trying to conceive as can harm any developing foetus

12

How can smoking affect fertility in men?

Can affect semen quality

13

What advice are women given about smoking when trying to conceive?

Smoking can harm any developing foetus

14

What advice are women given about their weight when trying to conceive?

Being BMI >30 or <19 may cause conception to take longer

15

How can a mans weight affect fertility?

Being over weight can reduce fertility

16

How are couples with infertility less than 18 months counselled?

By reassurance and lifestyle changes using a 'wait and see policy'

17

When is a 'wait and see' policy for infertility not recommended?

After 18 months and for women over 30

18

Why is a wait and see policy not recommended for women over 30?

Waiting may have a significant adverse impact on her lifetime chance of conception using IVF

19

Where should women over 30 with infertility be referred to?

Rapidly to a specialist infertility clinic that has access to a full range of assisted reproductive technologies

20

What reproductive technologies can be offered by specialist clinics?

- IVF
- ICSI
- Intrauterine insemination
- Donor sperm and oocyte

21

How does management of ovulation disorders vary?

Depending on the group of ovulation disorder

22

What advice is given to women with Group I ovulation disorders to improve their chances of conception and uncomplicated pregnancy?

- Gain weight (if BMI <19)
- Moderate exercise (if undertaking high levels of exercise)

23

What treatment can be offered to women with Group I ovulation disorders?

Pulsatile administration of gonadotrophin releasing hormone or gonadotrophins with LH activity to induce ovulation

24

What treatment options are available for women with Group II ovulation disorders?

- Clomiphene citrate
- Laparoscopic Ovarian Diathermy
- FSH injections

25

When is clomiphene citrate the drug of choice for Group II ovulation disorders?

When there is stigmata of PCOS, normal FSH and prolactin levels

26

What % of subjects will clomiphene induce ovulation in?

80%

27

What proportion of women who ovulate on clomiphene will be able to conceive?

Half

28

How is clomiphene administered?

From day 2-6 of the cycle with an initial dose of 50mg/day increased to 100 and 150mg/day where necessary

29

How can ovulation be measured when using clomiphene?

Measuring day 21 progesterone levels

30

Why may using day 21 progesterone levels to measure ovulation on clomiphene be an issue?

Some women will become pregnant upon resuming ovulation