Gynae Infertility

Question 1

What are possible cervical, uterine tubal and ovarian causes of infertility

Answer 1

Cervical: chronic cervicitis, cone biopsy,
Antisperm antibodies in the cervical mucus

Uterine: submucous fibroids, endometriosis/adenomyosis, anatomical, Asherman syndrome (scarring and fibrosis of endometrium following d&c)

Tubal: pid/ salpingitis, adhesions, endometriosis,

Ovarian: anovulation incl pcos (all the causes of amenorrhea)

Question 2

What cervical investigation is done in a woman with infertility

Answer 2

Sims huhner post coital test (pct)

Endocervical mucous collected by aspiration and foll examined:

Sperm count ; normal ~20 sperms per high power field
Ph normal 6.5-7.5..<6.2 poor prognosis
Spinnbarkeit- stretchy ability found in mucus

Question 3

What are three methods of assessing tubal patency

Answer 3

Hysterosalpingography - first line- xray contrast study

Laporascopy with due hydrotubation- gold standard preferred when known presence of pelvic disease or when hsg abnormal.. can directly visualize conditions such as pelvic adhesions and endometriosis

Hystero- contrast- sonography