Fertility Assessment and Pre-Conception Counseling

Questions and Answers

What should all women planning to conceive assess regarding their health?

Varicella status (correct)

Blood pressure status

Thyroid stimulating hormone levels

Body mass index

What is the recommended initial investigation for men seeking fertility assessment?

Thyroid function test

Hormonal profile test

Urinalysis

Semen analysis (correct)

What is NOT routinely recommended for women with a regular menstrual cycle?

Thyroid stimulating hormone testing

Ovarian reserve assessment

Baseline transvaginal pelvic ultrasound

Tests to confirm ovulation (correct)

Which test can be used to confirm ovulation if needed in women with a regular menstrual cycle?

Mid-luteal Progesterone Signup and view all the answers

What should be quantified to assess ovarian reserve?

Antral Follicle Count or Anti-Müllerian Hormone Signup and view all the answers

When should a baseline transvaginal pelvic ultrasound be ideally performed?

In the first 10 days of the cycle Signup and view all the answers

What procedure is recommended to assess tubal patency?

Hysterosalpingogram (HSG) Signup and view all the answers

Why is thyroid stimulating hormone testing reasonable in women presenting with infertility?

To exclude thyroid disorders that affect fertility Signup and view all the answers

What is the first line treatment recommended for women with anovulatory polycystic ovary syndrome (PCOS)?

Letrozole Signup and view all the answers

Which of the following conditions should lead to the consideration of oocyte donation?

Premature ovarian insufficiency Signup and view all the answers

When should Intrauterine insemination (IUI) be offered to couples?

To heterosexual couples with unexplained infertility or specific disorders Signup and view all the answers

Which statement is true regarding ovulation induction for women with proven ovulation?

It is not recommended for those with regular menstrual cycles. Signup and view all the answers

What is an appropriate follow-up for women undergoing ovulation induction with oral agents?

At least two cycles should be tracked with ultrasound. Signup and view all the answers

When dealing with disorders of ovulation not related to PCOS, which treatment option should be considered?

Gonadotropins or a GnRH pump Signup and view all the answers

What is the role of a multidisciplinary clinic for women with premature ovarian insufficiency?

To provide specialized care and counselling Signup and view all the answers

What should be considered if there is no ovulation after initial therapy in treating anovulatory PCOS?

Using gonadotropins or considering laparoscopic ovarian drilling Signup and view all the answers

Which couples are suitable candidates for IUI?

Couples with mild male factor and confirmed ovulation. Signup and view all the answers

When should IUI be scheduled in relation to ovulation?

Approximately 24 hours after LH positive urine or 0 to 36 hours post-trigger. Signup and view all the answers

Which of the following should be monitored during IUI cycles?

Ultrasound tracking of reproductive system. Signup and view all the answers

What is a consideration for referral to a tertiary fertility clinic?

Women with unexplained infertility. Signup and view all the answers

When should supportive care information be provided to couples undergoing fertility treatment?

During their first contact with a fertility specialist. Signup and view all the answers

Which condition is not eligible for IUI consideration?

Severe male factor infertility. Signup and view all the answers

What is a primary role of initial investigations in male fertility assessment?

To evaluate semen quality and quantity. Signup and view all the answers

Which criteria would indicate a low ovarian reserve?

Age 36 years or older. Signup and view all the answers

Study Notes

Fertility and Pre-Conception Assessment

Women's varicella status should be evaluated prior to conception through history or lab tests; non-immune women should receive varicella vaccination if possible.
All men planning conception should initially undergo semen analysis, compared to WHO reference values.

Initial Investigations for Women

Women with regular menstrual cycles do not routinely need tests to confirm ovulation.
If ovulation confirmation is needed, methods include mid-luteal Progesterone tests, urinary LH kits, or transvaginal ultrasound.
In cases where ovulation cannot be confirmed, a hormonal profile on Day 2-4 should include FSH, LH, and Oestradiol.
Ovarian reserve assessment can be done using Antral Follicle Count (AFC) and/or Anti-Müllerian Hormone (AMH).
A baseline transvaginal pelvic ultrasound with a high-frequency transducer is best conducted within the first 10 days of the menstrual cycle.
Tubal patency testing is performed using Hysterosalpingogram (HSG) or Hysterosalpingo-Contrast Sonography (HyCoSy) when no pelvic pathology is evident.
Checking thyroid stimulating hormone (TSH) is advisable for women presenting with infertility.

Treatment for Unexplained Infertility

Ovulation induction is not recommended for women with regular cycles who already show proven ovulation.
Intrauterine insemination (IUI) with ovarian stimulation is considered the first-line treatment for couples dealing with unexplained infertility.

Treatment Options for Ovulation Disorders

First-line treatment for women with anovulatory PCOS is Letrozole.
At least two cycles of ovulation induction using oral agents should be monitored via ultrasound.
If ovulation does not occur after initial therapy, gonadotropins may be introduced, with laparoscopic ovarian drilling as an option.
Assisted reproduction techniques may be necessary for women with refractory anovulatory PCOS.
Disorders causing ovulation issues not related to PCOS or low oestrogen should utilize appropriate forms of ovulation induction, such as gonadotropins or GnRH pump.

Treatment of Premature Ovarian Insufficiency

Referral to a specialized multidisciplinary clinic is recommended for women with premature ovarian insufficiency.
Oocyte donation is a viable option for these women following an appropriate specialist evaluation and counselling.

Indications for Intrauterine Insemination (IUI)

IUI is suitable for heterosexual couples with unexplained infertility, psychosexual disorders, or cervical factors, provided they meet eligibility criteria.
Couples/women considering treatment with donor sperm also qualify for IUI.
IUI should be considered for couples facing mild male factor infertility, stage I/II endometriosis, mild tubal disease, or confirmed ovulation post-ovulation induction.
Administration of IUI should occur only in stimulated cycles, with each cycle monitored via ultrasound.
Scheduling of IUI should align with ovulation, specifically 24 hours post-LH positive urine test or 0 to 36 hours after an ovulation trigger.

Referral to Tertiary Care

Consider referrals to a tertiary fertility clinic for women with very low ovarian reserve, those aged 36 years or older, instances of unexplained infertility, and those experiencing unsuccessful treatments with ovulation induction or IUI, including cases involving donor gametes or severe male factor infertility.

Patient-Centered Supportive Care

Couples should be given comprehensive information and access to mental health support resources during their initial visit with a fertility specialist, including details on counseling and support groups.

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Description

This quiz focuses on the essential assessments and investigations required for women planning to conceive, as well as the initial semen analysis for men. Understand the importance of varicella vaccination and the comparison of semen analysis with WHO reference values. Enhance your knowledge on pre-conception counseling and fertility assessments.