14. Female infertility Flashcards
Define: Infertility (1)
Inabilityto conceive after 1 yr of regular intercourse without contraception
Define: Fecundability (1)
Probability that a single cycle will result in pregnancy (20%–25%)
Define: Fecundity (1)
Probability that a single cycle will result in a ive irth
In women, there is a significant age-related ↓ fertility and ↑ in spontaneous miscarriage largely attributable to what? (2)
- progressive follicular depletion
- ↑ incidence of abnormalities of aging oocytes.
Infertility affects approximately __% of couples.
15%
Female-associated factors account for approximately __% of infertility problems.
50%
Male-associated factors contribute significantly to infertility in up to approximately __% of couples.
35%
Approximately __% of couples will have “unexplained infertility” (cause is uncertain).
10% to 15%
Describe phases and lengths of phases in Menstrual Cycle (4)
- Menstrual phase: 1 to 4 d
- Follicular phase: 5 to 13 d
- Ovulation: 14 d
- Luteal phase: 15 to 28 d
Name mechanisms of female infertility (3)
- Ovulatory dysfunction (20%–40%)
- Anatomic abnormality (25%–35%)
- Other (40% –45%)
Name DDX: Ovulatory dysfunction causes of infertility (6)
- Hypothalamic (hypothalamic disorder 2° to stress, poor diet, or excessive exercise)
- Pituitary (prolactinoma, medication-induced, hypopituitarism)
- Polycystic ovary syndrome (PCOS)
- Primary Ovarian Insufficiency
- Systemic disease (thyroid dysfunction)
- Anovulation associated with transition to menopause
Name DDX Anatomic abnormality causes of infertility: Uterine factors (4)
- Infection (chronic endometritis)
- Fibroids
- Congenital anomalies (agenesis, uterine septum, bicornuate uterus)
- Asherman syndrome
Name DDX Anatomic abnormality causes of infertility: Cervical factors (3)
- Acidic cervical mucus
- Antisperm antibodies
- Structural defects (previous LEEP, cone biopsy, cryo/laser Rx)
Name DDX Anatomic abnormality causes of infertility: Tubal factors (3)
- PID
- Tubal occlusion (previous ectopic)
- Tubal adhesions (previous surgery, endometriosis)
Name DDX other causes of infertility (3)
- Endometriosis
- Multifactorial
- Unexplained
Name Lifestyle factors Associated with infertility (5)
- Obesity
- Smoking
- EtOHuse
- Drug use
- Caffeine
Name Risk factors of infertility (6)
- Hx of PID
- Hx of tubal or pelvic surgery
- Hx of endometriosis
- Prev. EP
- Inutero DES exposure
- Hx of septic abortion
Describe approach of infertility (4)
- Evaluate for male infertility factor
- Determine whether patient cycles are ovulatory
- Identify factors that ↑ risk of tubal infertility
- Examine patient for signs and Sx of endocrinopathy and gynecologic disease
Describe Evaluation of Coital Practices (4)
- Sexual dysfunction (dyspareunia, impotence,etc.)
- Frequency of intercourse
- Timing of intercourse
- Use of lubricants
Describe: Physician’s Approach to Infertility (4)
- Discuss in a non judgmental manner
- Full disclosure to patients (make certain patients have full access to relevant information)
- Identify if certain options lie outside your moral boundaries and refer to another MD if appropriate
- Protect the patients’ right to freedom of moral choice
One year of infertility is not a prerequisite for who? (3)
- All women > 35yr
- Women with irregular or infrequent menses
- Women with a Hx of PID or endometriosis
Describe HX evaluation: Infertility (10)
- Developmental Hx
- Coital practices
- Previous STI
- Previous infertility
- Obstetric Hx
- Past surgical Hx
- FHx infertility
- Medications
- Substance abuse
- ROS (Sx of hyper PRL, FSH, etc.)
Describe HX evaluation: Physical exam (8)
- Breast (Tanner staging, discharge)
- Sx of hyperandrogenism
- Speculum and bimanual exam
- Cervial discharge
- Uterus/adnexa
- Tenderness
- Shape
- Mobility
How to R/O ovulatory dysfunction? (6)
- Basal body temperature graph
- Urinary LH
- D3 FSH, LH
- D 21-23 serum progesterone
- Serum TSH, PRL, 17-OHP
- Transvaginal U/S
