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
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
- Seminal volume, pH (not as important)
- Low threshold for urologic referral
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
- history consistent with ovulation
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
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
6
Q
How is the uterine cavity assesed?
A
- Hysteroscopy - gold standard
- Transvaginal ultrasound
- SIS
- HSG