TEALE FENNING Medical Education    FAQ   Search   Memberlist   Usergroups   Register   Profile   Log in to check your private messages   Log in  mrcog courses for doctors UK system          TEALE FENNING Forum Index -> MRCOG Part 2: Objective Structured Clinical Examination - the OSCE View previous topic :: View next topic   Author Message shama Joined: 17 May 2007 Posts: 44 Location: Malaysia Posted: Mon Oct 06, 2008 6:42 am    Post subject: UK system In UK, 1.Do the gynaecologists examine the men with oligospermia or refer them to urologists? Is it a routine to do FSH,LH levels in them to diagnose the level of problem and the type,obstructive, or nonobstructive? 2.Can you ask the women in UK directly like" Do you smoke? How much?" Do you drink or take alcohol? How much? Do you have bleeding after your sexual intercourse? Do you have painful intercourse? Deep dyspareunia??? How exactly to ask? 3. The venflon or iv access is sited by the doctor only? Nurses cannot be told to do this? 4.Dont you emphasize on two delivery sets, two paediatricians at the time of twin delivery? 5.What exactly is cyclokapron? Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Mon Oct 06, 2008 4:55 pm    Post subject: Shama - you need to split these - try to keep to one topic per post. N Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Mon Oct 06, 2008 5:50 pm    Post subject: Re: UK system shama wrote: 1.Do the gynaecologists examine the men with oligospermia or refer them to urologists? Is it a routine to do FSH,LH levels in them to diagnose the level of problem and the type,obstructive, or nonobstructive? We examine them - urologists have a limited role in the management of male subfertility. We generally only examine and investigate men with persistent oligospermia (confirmed by repeating the SFA at 3 months) or . These all require: 1. a detailed history (testicular descent, puberty, trauma, infection, surgery, drugs, smoking, alcohol, recreational drugs etc) 2. examination (BMI, secondary sexual characteristics, abdo mass, groin mass, external genitalia, testicular volume and consistency, presence of 3 structures in the cord, absence of mass / varicocele) 3. investigation (FSH / LH, testosterone, karyotype if severe or azoospermic when you also do a cystic fibrosis screen) Obstruction versus non-obstruction: this refers to the presence of azoospermia which should be confirmed by an immediate repeat SFA. You do a CF screen (some say only if you cannot palpate the vas but I do wonder how sensitive we are in doing this clinically so we do in all) and a FSH/LH. A. If the FSH is normal (<10-12IU/L will vary by lab but certainly <15IU/L) then we are probably dealing with obstruction (congenital or acquired eg infection, trauma, surgery) Rx surgical sperm recorvery which can be done during IVF treatment or as an elective investigative procedure and any sperm recovered frozen for subsequent use. B. If the FSH is >25IU/L we often diagnose testicular failure. One can recover sperm surgically on occasion but this is increasingly unlikely as the FSH increases abobe 15 IU/L and is rare beyond 25IU/L. Rx none, donor sperm (IUI or IVF), or adoption. NB all surgically retrieved sperm require ICSI for fertilisation. _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top shama Joined: 17 May 2007 Posts: 44 Location: Malaysia Posted: Tue Oct 07, 2008 1:31 am    Post subject: Thanks Nick.I shall keep in mind regarding splitting of the posts. Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Tue Oct 07, 2008 5:40 pm    Post subject: Just delete questions 2 onwards from the post above and post them each as a separate thread. I'd do it for you but believe it or not I can't! It would all come up under my name. Have a go as I guess you will get more replies that way. 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