Female Infertility 3 Flashcards

Describe the modern diagnostic approach to infertility.

1
Q

What are the key components of today’s evaluation of infertility?

A
  • Semen analysis
  • Documentation of ovulation
  • Assessment of ovarian reserve
  • Assessment of uterine cavity
  • Documentation of tubal patency
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2
Q

What are the components of the male factor evaluation?

A
  • Reproductive history
  • Semen analysis twice at least 4 weeks apart
  • Standard values from men whose partners had a time-to-pregnancy of less than 12 months
    • Seminal volume, pH (not as important)
      • > 1.5 mL
    • Sperm concentration
      • > 20 million/mL
    • Motility
      • > 50%
    • Morphology
      • >4% using strict criteria
  • Low threshold for urologic referral
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3
Q

What are some methods of assessment of ovulation?

A
  • Various methods acceptable
    • history consistent with ovulation
      • regular cycles
      • moliminal symptoms before menses
    • basal body temperature charting
    • determination of serum progesterone on day 21 of a 28 day cycle
    • home ovulation predictor kits
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4
Q

What are the most common test for ovarian reserve?

A
  • Day 3 FSH
    • FSH > 10-15 IU/L on day 2 or 3 considered abnormal
  • Anti-mullerian hormone (AMH)
    • produced by granulosa cells of preantral and small antral follicles
    • number of small antral follicles correlates with the size of the residual follicular pool
    • AMH levels decline as a woman approaches menopause
  • Antral follicle count (AFC)
    • transvaginal ultrasound measurement of follicles, 2-10 mm in both ovaries
    • indirect measure of ovarian reserve
    • histological studies have revealed that the number of small antral follicles in ovaries is proportional to the number of primordial follicles remaining
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5
Q

How is tubal patency assessed?

A
  • Hysterosalpinogram (HSG)
    • oil or water based dye injected through the cervix
    • pictures of the uterus and fallopian tubes are taken under fluroscopy
  • Saline infused sonohistogram (SIS)
    • simple, safe, inexpensive
    • ability to demonstrate tubal patency as high as 80%
      • BUT inferior to HSG when evaluating for tubal factor infertility
  • Historical gold standard - Laparoscopy with chromopertubation
    • risks of operation
    • exensive
    • time intensive
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6
Q

How is the uterine cavity assesed?

A
  • Hysteroscopy - gold standard
  • Transvaginal ultrasound
  • SIS
  • HSG
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