Infertility

Question 1

infertility
-definition
-cause
-

Answer 1

Definition:
-failure to conceive after one year of unprotected sex in women less than 35YO and after 6mo in women older than 35YO.

Cause:

• Tobacco, marijuana
• excessive exercise
• inadequate diet (extreme weight loss or gain)
• advanced age
• environmental and occupational

Question 2

What are some female factors contributing to infertility?

Answer 2

Cervical: stenosis or abnormality of the mucus-sperm interaction

Uterine: congenital or acquired defects may affect endometrium or myometrium

Ovarian: ovulatory dysfunction is an alteration in the frequency and duration of menstrual cycle (MC)**

Tubal: abnormalitis or damage to the fallopian tube. congenital or acquired

Peritoneal: anatomic defects or physiologic dysfunctions (e.g. infection, adhesions, adnexal masses)

Question 3

male factors affecting infertillity?

Answer 3

Pretesticular: congenital or acquired dz of the hypothalamus, pituitary, peripheral organs that later the HPA. (Ex. prolactinoma)

Testicular: genetic (klinefelters) or non-genetic (marijuana)

Posttesticualr: congenital or acquired factors that disrupt normal transport of sperm though the ductal system (DES, chlamydia, gonorrhea, trauma,etc)

…wearing tighty-whiteys and spending too much time in the hot tub.

Question 4

Infertility Evaluation:
-is testing required if couple has not been able to conceive for at least 1 year?

-

Answer 4

NO!

Question 5

Examination for Infertility

• in the female
• in the male

Answer 5

Female:

• obtain records of blood pressure, pulse rate, and temp
• calculate BMI
• perform eye exam for exopthalmos
• look for peicanthus, low setting ears, webbed neck = turners
• perform breast exam
• abdominal exam
• complete pelvic exam along with bimanual

Male;

• 1st: analysis of semen; look at concentration, motility, morphology, and viability
• -pH: 7.2-7.8
• -conc 20million or greater (if less than somethings going on)
• motility: 50% forward progression
• -WBC: fewer than 1mill cells
• cannot have ejaculated in the previous 5 days.

–if abnormal full GU exam, testicular size, and abdominal exam.

• free and total testosterone levels (blood test)
• obtain prolactin levels in men with low testosterone
• genetic testing with azospermia
• Ultrasound (varicocele)

Question 6

Work up of Female: possible causes of infertility relating to…

• cervical factors
• uterine factors
• studies for dx

Answer 6

Cervical:
-cervical stenosis

Uterine:

• absence of uterus
• vaginal septum
• fibroids

Studies:

• Hysterosalpingogram (HSG)
• Pelvic Ultrasound
• Saline infusion sonography
• hysteroscopy
• endometrial bx

Question 7

What is a hysterosalpingogram?

Answer 7

cervix prepped with betadine, breakaway speculum is used, single tooth tenaculum is used for traction of uterus, a balloon HSG catheter or metal cannula with a plastic acorn tip

*Most frequent tool used to evaluate endometrial cavity

Question 8

Ultrasonography helps in the detection of what conditions?

Answer 8

uterine fibroids

endometrial polyps

ovarian cyst

adnexal masses

endometriomas

*allows more precise evaluation of the position of the uterus within the pelvis.

Question 9

Saline infusion sonography; describe this

Answer 9

helps visualize the inside of the uterine cavity. fluid instilled into uterine cavity to provide enhanced endometrial visualization during transvaginal US.

Question 10

hysteroscopy; describe this.

Answer 10

gives direct visualization of endometrial cavity.

Question 11

what are the two most frequent tests used in the work up of female infertility caused by tubal and peritoneal factors?

How would you work up female infertility caused by ovarian factors?

Answer 11

Hysterosalpingogram & Laparoscopy

Ovarian factors could be worked up with:

• look into ovulation by these tests..(Ovulation kit, progesterone, US, basal body temp, FSH, prolactin, TSH)
• ovarian reserve
• -level of ovarian resever and age of the femal are the most important prognostic factors in fertility workup***
• -determined by checking day 3 FSH and estradiol level

Question 12

Tx of infertility

• for the couple
• female

Answer 12

couple: ideal intercourse frequency; intercourse on multiple days during the “fertile window”

avoid lubricants and douches

avoid alcohol, tobacco, and street drugs

offer emotional support

Female partner:

• ovulatory dysfunction:
• -treat underlying cause; thyroid, hyperprolactinemic anovulation (give bromocrriptine), PCOS (give metformin)
• -Clomid (Clomiphene)
• if clomid unsuccessful IVF and injectable ovulation inducing agents (human menopause gonadotropin, exogenous FSH & GnRH

*Bromocriptine is dopamine agonist

• tubal repair surgery
• for endometriosis: laparoscopic ablation or laparotomy