Infertility

Question 1

Infertility - Def

Answer 1

A woman of reproductive age who has not conceived after 1 year of unprotected sexual intercourse, in the absence of any known cause of infertility

Question 2

Infertility - Causes

Answer 2

o	Unexplained infertility
o	Ovulatory disorders
o	Tubal damage 
o	Male factors
o	Uterine or peritoneal disorders
o	Both male and female
o	Also embryo, uterine etc

Question 3

Infertility - Advices

Answer 3

o Vaginal sexual intercourse every 2-3 days (NICE 2013)
o Women drink no more than 1-2 units of alcohol once or twice a week
o Men 3-4 units per day
o Smoking reduce fertility (both genders)
o Passive smoking in women affect fertility
o No consistent evidence re caffeine and fertility
o Women and men BMI 30 or greater- reduce fertility
o Women BMI <19 and irregular menses -increase weight (US in anorexia nervosa, ovaries can look like PCOS)
o Men- association re elevated scrotal temperature
o Exercise
o Occupation-toxicchemicals
o Some prescription (NSAID affect semen, asthma medication, anti depressants), recreational drugs affect fertility
o No rigorous evaluation re CAM and infertility

Question 4

Infertility - Ix

Answer 4

o Semen analysis: volume 1.5ml or more, 15m spermatozoa per ml or more, motility, vitality, morphology
o Assessment of ovulation: blood tests
o Laparoscopy/hysteroscopy - tubal damage, uterine abnormalities
o Screen for infection

Question 5

Infertility - Tx

Answer 5

o Medical treatment- e.g. Ovulation induction
o Surgical treatment- e.g. ablation of endometriosis
o Assisted Reproduction
o Counselling
o Eggs: IVF, ICSI- intra-cytoplasmic sperm injection, IUI-intrauterine insemination, DI- donor insemination, GIFT

Question 6

Cx of fertility Tx

Answer 6

o Drug reaction
o Multiple births
o Ovarian hyper-stimulation syndrome: rare  swollen stomach, nausea abdominal pain, shortness of breath, reduce urine output
o Life threatening
o Association with some drugs/ treatment and ovarian cancer (ex: clomiphene)