26-Infertility

Question 1

What is fecundability?

Answer 1

Probability of achieving a pregnancy in any given cycle

Question 2

What is fecundity?

Answer 2

Ability to achieve live birth within 1 menstrual cycle (20%), in 3 months (50%), within 1 year (85-90%)

Question 3

What is infertility?

Answer 3

Inability to conceive within 1 year of frequent, unprotected intercourse

Question 4

What is the correlation between aging and reproduction?

Answer 4

Fertility peaks between age 20-24
Fertility gets lower as we age and steepen at 37
Decrease is due to declining and aging of oocytes

Question 5

What are the causes of infertility in couples?

Answer 5

Male factor (35%)
Ovulatory dysfunction 
Unexplained 
Unusual causes
Tubal or pelvic pathology

Question 6

What are the causes of infertility in women?

Answer 6

Ovulatory dysfunction (40%)
Unexplained
Unusual
Tubal or pelvic pathology

Question 7

What is the basic evaluation of a female with infertility ?

Answer 7

History ( prior pregnancies, surgery)
Physical exam (BMI, thyroid,anomalies)
Screening tests (pap,std, rubella)

Question 8

What is the evaluation of male ?

Answer 8

35% infertility is from male partners
Always order a semen analysis
If semen analysis abnormal refer to specialist
Normal semen: >20 million sperm, 50% forward motility, 50% normal morphology , 2 mL volume

Question 9

How to diagnose an ovulatory dysfunction ?

Answer 9

Basal body temp
Progesterone levels
Menstrual history 
Urinary LH
Endometrial biopsy
Only definitive evidence of ovulation is pregnancy all tests have limitations

Question 10

How to induce ovulation?

Answer 10

Treat other problems ie hypothyroidism
SERM therapy
Aromatase inhibitors
Insulin sensitizers in combo with other therapies
GnRH agonist

Question 11

What is used for SERM therapy ?

Answer 11

Clomiphene citrate is most commonly used

Tamoxifen

Question 12

What are the side effects and risks?

Answer 12

Hot flushes mood
Swings breast
Tenderness pelvic
Pain
Visual disturbances 
Multiple pregnancy rate

Question 13

What are the alternatives to clomid failure?

Answer 13

Insulin sensitizers-metformin induce ovulation in PCOS
Dexamethasone addition to clomid
Aromatase inhibitors- increase FSH

Question 14

What is the treatment of tubal infertility ?

Answer 14

Many reconstructive tubal surgical techniques exist but IVF more common due to financial reason

Question 15

What is the treatment of endometriosis from a fertility standpoint?

Answer 15

Medical therapy- no evidence

Surgery- restoration of normal anatomy , destruction of minimal or mild endometriosis lesions