Infertility

Question 1

Define infertility

Answer 1

inability to conceive or carry to term a pregnancy after 1 yr of regular, unprotected intercourse
Primary - infertility in the context of no prior pregnancies
Secondary - Infertility in the context of a prior conception

Question 2

numbers of couples that conceive and in what time frames

Answer 2

75% of couples achieve pregnancy within 6m
85% in a 1yr
90% with 2yr

Question 3

Females factors of infertility

Answer 3

Ovulatory dysfunction

• Hypothalmic
• pituitary
• ovarian: PCOS, premature ovarian failure, Luteal phase defect
• systemic disease e.g. thyroid, cushing, renal/hepatic failure
• congenital e.g. turner’s, gonadal dysgenesis or gonadotropic deficiency
• Stress, poor nutrition, excessive exercise

Outflow tract abnormality

• Tubal factors e.g. PID, adhesion, ligation/occlusion
• Uterine factors: congenital anomalies, bicornuate uterus, septet uterus, prenatal DES exposure, intrauterina adhesion, infection, fibroids/polyps, endometrial ablation
• Cervical factors: hostile or acidic cervical mucus, antisperm AB, structural defect e.g. cone biopsies, endometriosis, multiple factors, unknown factors

Question 4

Investigations for infertility

Answer 4

Female factors to investigate
1 Are there adequate functional and motile sperms - male factors
2 Is the woman ovulating - diagnosis of ovulation
detect by cycle and day counting
or progesterone levels
or follicule monitoring by USS
3 Can the sperm and egg meet - Tubal function tests
HSG - hysterosalp..gram - determines flow
Transvaginal scan with saline infusion - not used as it
4 Can implantation occur and be maintained - uterine and cervical factors
HSG - uterus
Hysteroscopy - uterus
5 assessment of ovarian reserve

Rubella Status

Question 5

Male factors to Ix for infertility

Answer 5

Male factors to investigate
Serum analysis - single most important test
Colour - gray, appearance - opalescent, door - musty
Look up properties
more than 5 mill sperm of good quality is fine.
Abnormalities - look up
oligozoospermia

Question 6

Tx for infertility

Answer 6

Induce ovulation e.g. clomiphene
- Increases secretion of FSH to higher level - recombinant of FSH
- followed by B hcG
- may add: dopamine agonist if prolactin elevated, steroid for CAH, Metformin for PCOS,
Surgery: Assisted reproduction technologies
e.g. tubuloplasty, lysis of adhesions, artificial insumination, IVF
- Manipulation of hormones
Sperm or ovum donor

Question 7

When should IX begin

Answer 7

under 35yr: after 1 yr of regular unprotected intercourse
35-40 yr: after greater 6m
greater then 40: immediately
Earlier if
- Hx of PID
- Hx of infertility in previous relationship
- Prior pelvic surgery
- Chemotherapy/rediation in either partner
- Recurrent pregnancy loss
- Moderate- severe endometriosis

Question 8

causes of male infertility

Answer 8

varicocele
idiopathic
ovstruction
Cryptorchidism
Immunologic