Common gynae histories - infertility Flashcards
What areas would you want to ask about for a couple presenting with subfertility?
- General - when they started trying
- Coitus
- Partners - consider each partner
- Women’s gynaecological health
What would you want to ask about coitus in a couple with subfertility?
- FRequency
- Difficulties
- Relation to fertile days
- Pain
What would you want to ask about each individual partner in a couple with subfertility?
- Age
- Accupation
- BMI
- Previous children - same/different partner
- Smoking and alcohol
- Current medications
- Mans PMHx
What features of subfertility would suggest PCOS as a cause?
- Acne
- Hirsuitism
- Secondary amenorrhoea
- Obesity
- Diabetes
What features associated with subfertility suggest fallopian tube damage?
- History of STI’s
- PID
- Pelvic surgery
What features associated with subfertility suggest endometriosis?
- Cyclical pelvic pain
- Dysmenorrhoea
- Deep dyspareunia
- Menstrual disturbance
What features associated with subfertility suggest a cervical obstruction (e.g. stenosis, hostile mucus, polyp, inflammation)?
- Previous cervical surgery
- Current STI symptoms
What features associated with subfertility suggest hyperprolactinaemia?
- Use of anti-psychotics
- Visual symptoms
- Galactorrhoea
What features associated with subfertility suggest hypothalamic disturbance (e.g. anorexia, stress, athletes)?
- Extreme anxiety, stress or exertion
- Poor diet
- Extreme efforts to lose weight/weight loss
- Low BMI
What questions would you ask about womens gynae health in someone having problems with subfertility?
- Gynae questions - discharge, pain, PV bleeding
- PCOS symptoms - hirsuitism, greasy skin, obesity
- Prolactinoma - galactorrhoea
- PMH - STIs, pelvic operations
What female problems can cause subferitlity?
- PCOS
- Endometriosis
- Fallopian tube damage
- Cervical barrier
- Hyperprolactinaemia
- Hypothalamic disturbances
- Hypogonadotrophic hypogonadism
- Hypergonadotrophic hypogonadism
- Congenital uterine/vaginal malformation
What are male causes of subfertility?
- Hypogonadotrophic hypogonadism
- Hypergonadotrophic hypogonadism
- Varicocele
- Anti-sperm antibodies
- Abscence/blockage
- Anatomical defects
What are coital difficulties which can cause subfertility?
- Mechanical problems
- ED
- Timing