Assessment of Infertility

Question 1

what examinations can be helpful in female infertility?

Answer 1

general (height, weight, secondary sexual characteristics etc)
pelvic examination (assess for tenderness, ovarian/uterine abnormalities and uterine mobility)
endocervical swab
cervical smear if due
trans-vaginal US is done to look for structural abnormality/pathology

Question 2

helpful examinations in male infertility?

Answer 2

general exam
genital examination looking at
- testes descended?
- bilateral presence of vas deferens
- bilateral presence of epididymis
- signs of variocele/other swelling
- testicular volume

Question 3

normal testicular volume in adult male?

Answer 3

12-25ml

Question 4

how can semen be analysed?

Answer 4

seminogram evaluates semen and sperm cells - measures volume of semen

• pH of semen
• density and conc of sperm in sample
• sperm motility (what proportion are moving)
• sperm progression (how well they are moving)
• sperm morphology

Question 5

normal sperm pH?

Answer 5

7.2 or above

Question 6

how is sperm sample collected and analysed?

Answer 6

no ejaculation for 72 hrs before giving sample
no caffeine or alcohol recommended in days before
complete sample obtained
sample assessed within 1hr of production
sample kept at body temp

Question 7

how can tubal patency be assessed in females?

Answer 7

laparoscopy (preferred where there is possible tubal disease or pelvic inflammation such as PID or previous pathology such as ectopic)
hysterosalpingogram can be done if laparoscopy is contraindicated and there are no known risk factors for tubal/pelvic disease

Question 8

when might laparoscopy be contraindicated?

Answer 8

obesity

crohns

Question 9

what further tests might be done to investigate infertility?

Answer 9

hysteroscopy (if known or suspected endometrial pathology)
scrotal US (abnormality on examination)
chromosome analysis
endocrine profile

Question 10

what endocrine tests would be done on males and females?

Answer 10

male = FSH, LH, testosterone, prolactin, TSH
female = FSH, LH, oestradiol, mid-luteal progesterone, free androgen index, testosterone and SHBG, prolactin, TSH