Fertility Flashcards
Infertility requires referral from GP when…
Fails to conceive after 12 months / 6 months (in >35)
The most common cause of infertility is…
Low sperm count
25% of sub-optimal fertility is caused by…
Ovarian dysfunction
15% of sub-optimal fertility is caused by…
Tubal dysfunction
10% of sub-optimal fertility is caused by…
Uterine abnormalities
General advice for the promoting fertility
- Taking folic acid 400mcg daily
- Avoid smoking/ drinking excessively
- Aim for healthy BMI
- Sexual intercourse every 2-3 days
- Avoid stress
- Avoid timing intercourse
______ % of couples will natural conceive if they have regular sexual intercouse _______ times a day for ______
84%, 2-3x/ day, 1 year.
Initial investigations for women for infertility
Mid-luteal phase progesterone
Serum gonadotrophins (irregular cycles)
TFTs (if symptomatic)
Prolactin (if suspected)
Chlamydia screen
Initial investigations for men for infertility
Semen analysis
Chlamydia screen
Examples of assisted conception
Intrauterine insemination
iVF
Intracytoplasmic sperm injection
Examination for infertility in women
BMI- obesity
PCOS: hirsuitism, acne, abdo exam (cyst)
Pelvic exam: infection, mass, PID, cyst, fibroids
Vaginal: vaginismus.
Examination of for infertility for men
Penile examination
- Urethral meatus/ structural abnormalities
Scrotal examination
- Lumps
- Soft testes= hypogonadism
- Undescended tests
Hypogonadism
- Secondary characteristics
- Gynaecomastia
Risk factors for primary spermatogenic failure/ obstructive azoospermia
Infection
- Mumps
- STI
Testicular trauma/ torsion
Undescended testes/ surgery
Systemic disease
- CKD, CVD, cancer
- DM, cirrhosis, thyrotoxicosis
Medical treatment for infertility in women
1st
- Clomifene
2nd
- Gonadotrophins
3rd
- Pulsatile GnRH
______ or______ is indicated for women with mild tubal disease in infertility
Tubal catheterisation/ cannulation
