Infertility

Question 1

When should a first consultation and evaluation occur

Answer 1

after 1 year of failure at any age
OR earlier with:
>35 yo, male factor infertility, previous infection, disease, or surgery, DES exposure, previous infertility

Question 2

Methods to prove ovulation

Answer 2

Hx: regular, cyclic, and predictable menses with phase change; keep patient log
Ovulation Predictor Kits: assist in monitoring mid-cycle LH surge that precedes ovulation
Basal Body Temp: taken in the AM, during follicular phase

Question 3

Semen testing and values

Answer 3

must be obtained 48-72 hrs after abstaining from intercourse
must be kept at body temp
pH >7.2
sperm concentration >15 million/mL
motility >40 %, >32% with rapid forward progression
morphology normal sperm >4%
WBCs fewer than 1 million cells/mL

Question 4

testing for egg meeting sperm/implantation

Answer 4

vaginal cultures
pelvic US
hysterosalpingography: test the patency of the uterine and fallopian structures
laparoscopy
endometrial biopsy
postcoital test (Huhner’s test): not often used

Question 5

treatment options

Answer 5

Clomiphene citrate (clomid): causes ovulation induction
pituitary recognizes a decreased level of estrogen and increases the secretion of LH and FSH which promote maturation and release of the egg
Human Chorionic Gonadotropin: triggers ovulation; given when follicles reach appropriate size for ovulation
Progesterone: stabilizes endometrium; indicates endometrial lining to stop growth and prepare for implantation

Question 6

Causes of infertility

Answer 6

cervical (infections, cervical mucus, hostility towards sperm)
Uterine and/or tubal (congenital or acquired)
Endometrial (endometritis, menstrual cycle irregularities, trauma)
peritoneal (endometriosis, adhesions, distal tubal occlusions, ovarian cysts)
ovarian/ovulatory (R/O pituitary, ovary, uterus, adrenal, and thyroid disorders)
Male (varicocele, azoospeia, oligospermia, testicular temp, and trauma)
Unexplained