Infertility Flashcards
Male Factors Affecting Fertility
Varicocele - most treatable - ligation
Testicular Dysfunction
Obstruction
Female Factors Affecting Fertility
Ovarian, Tubal, Uterine, Cervical, Peritoneal
When do do an infertility eval?
After 1 year of unprotected intercourse
After 6 mo for women >35
As soon as pregnancy desired if: oligomenorrhea, tubal disease, hx of partner infertility
Common Causes of Anovulation
PCOS, Hyperprolactinemia, Hypothalamic dysfunction, Primary Ovarian Insufficiency, Thyroid dysfucntion
Who to test ovarian reserve?
all women 35+ w/ infertility. unexplained infertility or recurrent miscarriage. risk for diminished ovarian reserve: endometriosis, smoking, family hx of early menopause, ovarian surgery, severe adhesive dieases)
Assessment of Ovarian Reserve
Day 3 serum FSH and estradiol
Clomiphene citrate challenge test
Ovarian volume (ultrasound)
Tests for tubal factors
Hysterosalpingogram (HSG), Laparoscopy with chromotubation, Tubal cannulation at HSG or laparoscopy, Infusion of fluid into uterus and confirmation of tubal patency during ultrasound
Uterine Assessment
Hysterosalpingogram (HSG), Saline hysterogram, hystroscopy, MRI, Endometrial biopsy
Tests for Cervical Factors
Cervical cultures for infections. Postcoital test
Maximize Natural Fertility
Intercourse every 1-2 days within 2 days of ovulation. Healthy living/diet/weight. No smoking/alcohol/excess caffeine.