Infertile couple

Question 1

Infertile couple:

How common is it and the normal rates of conception?

Answer 1

10 - 15% of couples will experience infertility

under the age of 35yo there is a 20% chance of conception per menstrual cycle and by 12 months 90% will conceive

Question 2

Infertile couple:

Causes of infertilty by gender?

Answer 2

Male:
-thyroid disorder
-smoking 
-substance use - including anabolic steroids
-Chemo or radiotherapy exposure
-Genetics (Kleinfellters and Kallman syndrome)
-Sperm related issues (sperm 60%, obstruction 25%, disordered ejaculation/intercouse 10%, antibodies to sperm 5%, hypothalamic pituitary axis issues 1%)
eg.
-undescended testes
-testicular trauma
-anatomy changes
-absent vas deferens
-infections (orchitis, STI's)
-erectile dysfunction
-retrograde ejaculation

Female:
-thyroid disorder
-smoking 
-substance use - including anabolic steroids
-Chemo or radiotherapy exposure
-Genetics (Turners syndrome)
-Egg related issues
eg.
-anovulation (PCOS, stress, low body weight)
-endometriosis
-PID/tubal disease
-premature ovarian insufficiency

Question 3

Infertile couple:

Best intercourse timing for conception?

Answer 3

intercourse every 2 - 3 days in the week leading up to ovulation and the day after

Question 4

Infertile couple:

Work up of infertile couple?

Answer 4

Male:

1) Examine
- examine for virilisation
- examine testes size and consistency
- examine scrotal abnormalities eg varicocoele
2) Sperm analysis
3) Bloods
- FSH, LH
- testosterone
- TSH, FT4
4) if abnormalities found specialist for karyotype testing

Female:

1) Day 2 - 6 of cycle bloods
- FSH, LH, oestradiol, Prolactin
- TSH, FT4
2) Day 21 of cycle blood (or weekly if irregular cycle)
- Progesterone (to check ovulation)
3) TV USS on Day 3 of cycle
- antral follicle count
- uterine/adnexa structural review
4) Specialist for laparoscopy and histosalpingogram if required

Question 5

Infertile couple:

Management?

Answer 5

General

• smoking cessation
• no alcohol ideally
• cease illicit substance use
• weight loss if above normal body weight (5%)

Then targets sepcifics:

• treat PCOS
• manage endometriosis (laparoscopic surgery to increase fertility in the 6 months post procedure)
• triggered ovulation eg. clomiphene
• intracystoplasmic sperm injection (ICSI)
• IVF