Infertility

Question 1

def. of infertilty

Answer 1

no preg after trying for 12 months

- secondary if have had a child

Question 2

incidence of infert

Answer 2

• 10-15% of couples

- 80% preg. after first year

Question 3

2 main causes of infert.

Answer 3

1. male factor
2. tubal
   - then
   - ovulation
   - endo
   - cervical
   - mixed

Question 4

how does age play a role

Answer 4

increases with age

Question 5

tubal factors involved

Answer 5

1. PID and endo
2. adhesions
3. ruptured appendix
   4, imperforate hymen leading to retrograd menstruation

Question 6

what is test for tubal facotrs

Answer 6

hysterosaplingogram (HSG) with dye

Question 7

what is normal HSG

Answer 7

fluid filled and spilled

Question 8

what is seen in tubal issues

Answer 8

maybe not filled, maybe not spilled

Question 9

what is seen hydrosalpinx

Answer 9

filled and swollen

Question 10

what is relat between endo and fertility

Answer 10

30-40% of endo PTs will be infertile

- found in 35% of women undergoing infert lapro

Question 11

what can help

Answer 11

treatment of stage 1 and 2 endo can improve fert

Question 12

what are 4 uterine factors

Answer 12

1. congential anomalies
2. ashermans - scarring inside the uterus
3. fibroids
4. polyps

Question 13

how to diagnose uterine probs

Answer 13

HSG or sonohystogram

Question 14

2 treatments

Answer 14

1. hyseroscopy or open surgery

2. metroplasty - rare

Question 15

** what is diff. between uterine septum and bicornate

Answer 15

can see a bicornate from the outside, but septum will look normal

Question 16

what are cervical factors

Answer 16

1. previous cervicitis
2. cone biposy
3. antisperm AB

Question 17

2 tests for cervical factors

Answer 17

1. post coital test - not really done

2. sperm peenetration test - mix mucus and semen under a microscope and watch them swim

Question 18

2 main classes of male problems

Answer 18

1. not enough

2. poor delivery

Question 19

what is normal semen analysis

Answer 19

volume - 2-5 cc
conc. 20-40 mill
motility: 50%
morphology : >4%
leukocytes: ideall 0

Question 20

what is DNA fragmentations

Answer 20

test the sperm - poor > 30% good

Question 21

possible causes of male factor

Answer 21

• congential - undescended
• trauma
• varicocoele
• infection
• cancer/chemo
• smoking, pot, heat
• CF
• retrograd ejac

Question 22

treatment of ovulation problems

Answer 22

1. fix underlying cause if possible
2. stim ovulation if possible
3. donor egg if not
4. same workup as ammen

Question 23

3 drugs for infert.

Answer 23

1. SERM - clomiphene
2. est. aromatase inhibitor - letrozole
3. rFSH - expensive

Question 24

3 treatments of tubal disease

Answer 24

1. tuboplasty
2. IVF
3. remove hydrosalpinx before IVF

Question 25

3 treatments of endomet

Answer 25

1. laprascopic surg
2. IVF if tubal
3. ovulation induction and IUI

Question 26

treatment of uterine factors

Answer 26

1. fix uterus

2. surrogate

Question 27

treatment of cervical factor

Answer 27

IUI

Question 28

treatment for male factors

Answer 28

1. avoid heat
2. multivits.
3. stop bad habits
4. donor sperm
5. IUI
6. IVF
7. sperm extraction