flashcards_subfertility
What blood hormone profile should be investigated in subfertility?
Early follicular phase FSH, LH, and oestradiol levels (day 2-3), mid-luteal progesterone.
What is the significance of Anti-Mullerian hormone (AMH) in subfertility investigations?
AMH is helpful for assessing ovarian reserve as it is independent of the menstrual cycle and is the most successful biomarker of ovarian reserve.
What additional tests should be considered if the menstrual cycle is irregular?
TFTs, prolactin, and testosterone.
What STI screenings should be done in subfertility investigations?
Chlamydia screening in men and women, HIV, hepatitis B, and hepatitis C screening if assisted reproductive technology (ART) is being considered.
What does TVUSS assess in subfertility investigations?
Assessment of pelvic anatomy and antral follicle count (important parameter of ovarian reserve).
How is tubal assessment usually performed in subfertility investigations?
Hysterosalpingography (HSG) using X-ray or ultrasound or a laparoscopy and dye, HyCoSy (hysterosalpingo contrast sonography).
What is the significance of semen analysis in subfertility investigations?
Semen analysis usually consists of 2 tests which are done 3 months apart.
What are some conservative management strategies for subfertility?
Regular intercourse, reduce smoking, reduce alcohol intake, address obesity and low body weight, address drug use, stress management, occupational risks, caffeinated beverages, and give relevant pre-conception advice (e.g., folic acid use).
What is the first-line medical management for anovulation in subfertility?
Ovulation induction with clomiphene or FSH.
What is the indication for intrauterine insemination (IUI) in subfertility?
Unexplained subfertility, anovulation unresponsive to ovulation induction, mild male factor, minimal to mild endometriosis.
When is donor insemination considered in subfertility management?
Presence of azoospermia, single women, same sex couples.
What are the indications for in-vitro fertilisation (IVF) in subfertility?
Patients with tubal pathology, patients who underwent above treatments with no success.
What are the surgical management options for subfertility?
Operative laparoscopy to treat disease and restore anatomy, myomectomy, tubal surgery, laparoscopic ovarian drilling.
What are the risk factors for subfertility?
Advanced maternal age, smoking and alcohol use, obesity, irregular periods, STI, low BMI.
What should be explained to patients about the likelihood of conception within the first year of trying?
80% of couples will fall pregnant if trying regularly for 12 months (& of those that don’t, 50% will conceive in the 2nd year of trying – cumulative pregnancy rate of 90%).
