EBCOG Part 1 – 2 Months Subfertility – DAY 1

1. A couple presents to the subfertility clinic with failure to conceive inspite of trying for past 2 years.The investigations done on the female partner are normal.The partner has the following–36 yrs-cigarettes smoker-20/day,alcohol-20 units/week.He has a h/o mumps in childhood.Semen analysis done twice shows absence of sperms.Hormonal profile-FSH & LH are raised,testosterone is low.Karyotype is normal & there is no Y chromosome deletion.How would you manage the couples infertility ?

2. The normal parameters for a  semen analysis as per the WHO includes which of the following?

3. A 32 year old male presents with his partner at the clinic for failure to achieve a pregnancy. The semen analysis shows the following—volume-3ml,total sperm count-20 million,sperm conc—10million/ml,pH>7.2,overall motility—15%,normal forms—1% & vitality—25%.

4. A couple is seen in the subfertility clinic.After investigations,the female parameters are found to be normal.The semen analysis shows azoospermia.Repeat sample also shows same finding.Which one of the following condition is unlikely to cause this finding in the male?

5. One of your junior colleagues wants to know what is meant by mild male factor infertility.What will you tell?

6. A boy 16 years old has Hodgkins lymphoma.His parents come to see you requesting counselling about preservation of fertility.what will you tell them?

7 . A couple comes to for advise in the subfertility clinic.They tried unprotected intercourse for 3 months,but the male partner has problem with lifelong premature ejaculation.What would be the first line management?

8. Which cell type is the end product of meiosis in the testes?

9. In the UK ,what proportion of subfertility is attributable to male factors?

10. Following fertility investigations,a man is found to have oligospermia.No cause for the oligospermia was found.He was labelled as a case of idiopathic oligospermia.He wants to know what is the best treatment for him?what will you tell him?

11. A couple is seen in the subfertility clinic & on examination of the male he is found to have a varicocoele.What information will you give him about varicocoeles?

12. A 35 year old woman has been referred to the subfertility clinic.She is trying to conceive for the past 2 years.Her cycle length is 35 days.Ultrasound shows 2 small intramural fibroids & evidence of polycytic ovaries.Her serum progesterone 8 days prior to onset of menstruation is 20 ng/ml.A HyCoSy done recently shows tubes are patent.Her BMI is 35 & she h/o smoking 5 cigarettes per day.Semen analysis of the husband is within normal limits.She wants to discuss her options for subfertility treatment.

13. A 40 year old who is a P2 c/o absent periods for past 10 months.She gives h/o weight of 10 kg over past year.Her pelvic exam is normal .A TVS shows picture which is suggestive of PCOS.What investigation is most appropriate for her now?

14. A 30 year old woman who is a P1 presents with amenorrhea of 6 months duration.she gives h/o weight gain over these months .The pelvic exam is normal.TVS shows a picture suggestive of PCOS.She is not interested in child bearing right now.What is the best treatment option for her?

15. A 25 year old presented with oligomenorrhea,weight gain & increased facial hair over past 2 years. Her BMI is 40 kg/m2.She was diagnosed with polycystic ovarian syndrome& advised life style changes with weight loss.The advise didn’t help her.She is not interested in child bearing now.But will consider it later.What is the next best option that can be considered with respect to her losing weight?

16. A 21 year old with a BMI of 22 is diagnosed to have PCOS.Her mother has type DM & an elder sister developed GDM in pregnancy.She is very concerned about developing type 2 DM hereself.Her OGTT showed a fasting glucose of 6.5 mmol/L.What is the recommended measures for her to prevent type 2 DM?

17. Which is the first line drug recommended by NICE for pharmacological treatment of anovulatory polycystic ovarian syndrome?

18. What proportion of women with polycystic ovarian syndrome are overweight/obese?

19. How does metformin work?