Infertility

Question 0

Primary versus secondary infertility?

Answer 0

Never been pregnant versus previous pregnancy

Question 1

Five factors to consider with infertility?

Answer 1

1. Ovulation
2. Uterine
3. Tubal
4. Male factor
5. Peritoneal factor (endometriosis)

Question 2

Fecundability? Estimated as?

Answer 2

Probability of achieving a pregnancy within one menstrual cycle; 20-25%

Question 3

Ovulatory disorders – account for how much if female infertility? Assess with?

Answer 3

30-40%;

1. HISTORY of regular menses
2. biphasic basal body TEMPERATURE
3. Midluteal (date 21) serum PROGESTERONE
   4 ENDOMETRIAL biopsy showing secretory tissue
4. ULTRASOUND documenting decrease follicular size and presence of fluid in the cul-de-sac

Question 4

Uterine problems – initial test? Performed when? If defect, use this test? Possible causes of infertility?

Answer 4

Hysterosalpingogram between days 6-10 cycle; hysteroscopy; submucosal fibroid

Question 5

Tubal factor – gold standard of evaluation? Otherwise can use?

Answer 5

Laparoscopy; Hysterosalpingogram

Question 6

Abnormality of male factor – test? To diagnose?

Normal volume? Concentration? Mobility? Morphology?

Answer 6

Semen analysis; two analyses, 2-3 months apart

Volume >2 mL
Concentration >20 million
Motility >50%
Morphology >30%

Question 7

Peritoneal factor – suspect with? Diagnosed with? Classic lesion?

Answer 7

Endometriosis – three D’s: dysmenorrhea, dyspareunia (Pain with intercourse), dyschezia (Difficulty defecating)

“Powder burn” lesion

Question 8

Infrequent etiology of infertility? Suspect if? Treatment?

Answer 8

Cervical factor; thick viscous cervical mucus; intrauterine insemination

Question 9

Likely past medical history in a patient with:

1. Ovulation dysfunction
2. Uterine disorder
3. Male factor defect
4. Tubal defect
5. Peritoneal factor defect (endometriosis)

Answer 9

1. Irregular menses, obesity
2. Fibroids
3. Hernia, varicocele, mumps
4. Chlamydia or gonococcal infection
5. Dysmenorrhea, dyspareunia, dyschezia

Question 10

Best test if patient suspected to have:

1. Ovulation dysfunction
2. Uterine disorder
3. Male factor defect
4. Tubal defect
5. Peritoneal factor defect (endometriosis)

Answer 10

1. Basal body temperature, LH surge level, progesterone level
2. Hysterosalpingogram
3. Semen analysis
4. Hysterosalpingogram
5. Laparoscopy

Question 11

Tx for a patient with:

1. Ovulation dysfunction
2. Uterine disorder
3. Male factor defect
4. Tubal defect
5. Peritoneal factor defect (endometriosis)

Answer 11

1. Clomiphene citrate
2. Hysteroscopic procedure
3. Repair of hernia/varicocele, in vitro fertilization
4. Laparoscopy, IVF
5. Ablation of endometriosis