Infertility Flashcards
A couple presented to the gyne clinic with complaints of difficulty achieving pregnancy × 3 years duration.
Grip+ LCCC
Ask
- ASK: What do you know about infertility?
TELL: DEAR CDT
Define: Infertility is the inability of a couple of reproductive age group to achieve and sustain pregnancy after one year of adequate, regular, unprotected, vaginal ejaculatory intercourse.
Key words** RVP (EU)- regular, vaginal, penetrative, ejaculatory, unprotected
b. Epidemiology: It affects 20-30% of couple in Nigeria (About 2-3 couples in
10). Women over 35 years experience infertility at higher rates due to age related changes in fertility.
c. Aetiology/Risk factors: The man and woman contribute equally to the causes of infertility. Both contribute about 10%
Male causes include: Poor sperm quality, Diabetes mellitus, Erectile dysfunction, Congenital causes e.g undescended testes, Varicocele (swollen veins around testes affecting sperm production), Untreated/poorly treated childhood mumps etc
Female causes: Hormonal disorders, fibroids, uterine abnormalities, tubal blockage (damage to fallopian tubes due to infections), Ovulation disorders like anovulation, PCOS, Abdominal factors like appendicitis, perforated typhoid (leading intraabdominal adhesion/scarring), Pelvic surgeries (leading peritubal, uterine adhesions/scarring) etc
Unexplained infertility: cannot be attributed to either male or female despite all investigations.
d. Types:
Primary: Failure to conceive after one year in a couple who have never been pregnant
Secondary: Failure to conceive after one year in a couple who have been pregnant in the past irrespective of outcome.
e. Complications: Untreated infertility may lead to depression, relationship strain, emotional stress etc.
However, with proper management, many couples go on to have children and emotional effects can be minimized with the right support.
f. Diagnosis:
To help with our treatment, we will do some investigatoons which include:
Man: Seminal fluid analysis (SFA), Blood sugar, urinalysis
Woman: Ultrasound scan, Confirmation of tubal patency (HSG), Hormonal
profile etc
Treatment options
Treatment options:
Appropriate treatment will be started depending on the cause of infertility:
*Lifestyle modification:
Diet: Balanced diet high in fruits, vegetables and healthy fats can support fertility. Reduce processed foods and caffeine.
Regular exercise: moderate exercise can help regulate hormones and improve fertility. Avoid strenuous/excessive exercise.
Stress management: Relaxation techniques like yoga, meditation or counseling can reduce stress levels.
*Medical treatment: Ovulation induction agents like clomiphene, letrozole can be used to stimulate the ovaries, Hormonal replacement (LH, FSH), Treatment of high prolactin with carbergolin, bromocriptine
*Surgical: Fibroid surgery (myomectomy), removal of ahesions (adhesiolysis), Varicocelectomy for males.
*Assisted reproductive techniques:
Intrauterine insemination (IUI): involves placing sperm directly into the uterus during ovulation to increase chances of conception.
ii. in vitro fertilization (IVF) - More advanced procedure where eggs are retrieved, fertilized outside the body with partner’s sperm and the resulting embryos are transferred into the uterus for continuation of pregnancy.
iii. Sperm donor, egg donor (third party)- In the case of testicular failure or ovarian failure.
iv. Surrogacy: In case of uterine problems or medical conditions (eggs are retrieved, fertilized outside the body with partner’s sperm and the resulting embryos are transferred into another woman who acts as an incubator and carries pregnancy till delivery.
*Other options: Adoptions can be considered as well.
HELP
:
Join support groups for emotional support
Employ strategies to minimize stress
Debunk myths “washing womb” ie D&C (it worsens rather than improving condition)
Stop smoking and drinking alcohol
EMPATHY:
I understand the many issues surrounding infertility, but thankfully medicine has evolved to help provide various means of achieving your dreams. The team of Doctors are excellent at what they do and are here to help. So do not be worried.
RETELL:
Do you understand all I have said?
Do you have any questions for me?
Can you retell what you understand in your own words
Discuss it over with your spouse and i’ll see you in 1 week for a follow up visit
Thank you sir/ma.
