Infertility

Question 1

what is infertility? when is a w/u warranted?

Answer 1

no conception after 12M of trying for <35Y
no conception after >6M for 35-40Y
immediately for >40Y

Question 1

T/F: most commonly the cause of infertility is female related, then male, then idiopathic

Answer 1

35% is due to male infertility
50% is due to female infertility
15% is idiopathic

Question 2

what are common buckets to think about causes of male infertility?

Answer 2

1. issues with sperm production
2. issues with sperm motility
3. issues with sperm transport
4. sexual dysfunction

Question 3

what are common buckets to think about causes of female infertility?

Answer 3

1. issues with the uterus
2. issues with the fallopian tubes
3. issues with the ovary

Question 4

what are some etiologies related to the uterus for female infertility?

Answer 4

• fibroids/polyps
• congenital anomalies
• adenomyosis: endometrium tissue grows into the myometrium
• cervical stenosis
• hostile uterine environment

Question 5

what are some etiologies related to the fallopian tubes for female infertility?

Answer 5

• pelvic inflammatory disease
• endometriosis
• adhesions
• congenital anomalies

Question 6

what are some etiologies related to the ovaries for female infertility?

Answer 6

• PCOS
• obesity
• premature ovarian failure
• Tuner
• wt loss/malnutrition
• tumours

Question 7

what ix would you order to work up infertility?

Answer 7

1. semen analysis
2. confirm ovulation and evaluate ovarian reserve: day 3 FSH +/- estradiol (reserve), and a day 21-23 progesterone/mid-luteal phase progesterone (ovulation)
3. evaluate fallopian tube patency: HSG or SHG

Question 8

what non first line ix could you also consider for infertility?

Answer 8

male
- postcoital urinalysis ➔ esp if little volume in semen sample
- anti sperm antibodies
- hormones: FSH, testosterone, LH, prolactin +/- TSH, estradiol
- genetic testing
- scrotal u/s
- STI testing
- infectious - hep B/C, HIV

female
- anti Mullarian hormone - assess ovarian reserve
- hormones: FSH, estradiol, LH, prolactin, TSH, testosterone
- STI testing
- infectious - hep B/C, HIV

Question 9

how do you tx infertility?

Answer 9

1. pt education and counselling + at home LH kits for ovulation
2. refer to a fertility specialist
3. clomiphene citrate
4. letrozole
5. GnRH therapy - controlled ovarian stimulation
6. intrauterine insemination
7. IVF
8. Adoption
9. surrogacy
10. embryo adoption