Infertility

Question 1

Male Factors Affecting Fertility

Answer 1

Varicocele - most treatable - ligation
Testicular Dysfunction
Obstruction

Question 2

Female Factors Affecting Fertility

Answer 2

Ovarian, Tubal, Uterine, Cervical, Peritoneal

Question 3

When do do an infertility eval?

Answer 3

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

Question 4

Common Causes of Anovulation

Answer 4

PCOS, Hyperprolactinemia, Hypothalamic dysfunction, Primary Ovarian Insufficiency, Thyroid dysfucntion

Question 5

Who to test ovarian reserve?

Answer 5

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)

Question 6

Assessment of Ovarian Reserve

Answer 6

Day 3 serum FSH and estradiol
Clomiphene citrate challenge test
Ovarian volume (ultrasound)

Question 7

Tests for tubal factors

Answer 7

Hysterosalpingogram (HSG), Laparoscopy with chromotubation, Tubal cannulation at HSG or laparoscopy, Infusion of fluid into uterus and confirmation of tubal patency during ultrasound

Question 8

Uterine Assessment

Answer 8

Hysterosalpingogram (HSG), Saline hysterogram, hystroscopy, MRI, Endometrial biopsy

Question 9

Tests for Cervical Factors

Answer 9

Cervical cultures for infections. Postcoital test

Question 10

Maximize Natural Fertility

Answer 10

Intercourse every 1-2 days within 2 days of ovulation. Healthy living/diet/weight. No smoking/alcohol/excess caffeine.