Infertility Flashcards
What is infertility?
35yo: unprotected intercourse for 6mo
What can cause fallopian tube damage?
endometriosis
pelvic adhesions - appendix
PID
What are uterine factors?
submucosal uterine fibroid*
congenital abrnomalities
scarring of uterine wall from infxn and surgical procedures - asherman’s sx*
What are cervical factors?
cervical stenosis*
congenital abnormalities
antibodies against sperm in cervical mucus
What to ask - hx?
pregnancies menstrual hx prior infxn surgical procedures family hx of endometriosis timing of intercourse w/ ovulation
PE?
hirsutism - male hair pattern
galactorrhea
thyroid exam
Pelvic PE?
cervical abnormalities
signs of infxn - friable
fundal size and masses
ovarian masses - nodularity,endometriosis
Evaluate ovulatory fxn?
urine ovulation kits
mid-luteal phase serum progesterone level
How to check uterine and tubal factors?
US - day 2, 3, 4 of cycle
hysterosalpinography - checks obstructions/structural abnomalities
What labs to draw?
TSH, prolactin
pre-pregnancy screen - CBC, blood type, RH factor, rubella titer
infectious screen - Ch/Gn, syphilis, hep
How to tx oligomenorrhea w/ hyperprolactinemia?
bromocriptine
NO ovulation in 2 mo –> ADD clomid
How to tx tubal factors?
tubal flushing
in vitor fertilization
tubal reconstruction
How to tx endometriosis?
laparoscopic removal
How to cervical factors?
tx infxn
cerivcal dilation of stneosis
artificial insemination to bypass abnormalities
