Infertility (7.2)

Question 1

What is infertility?

Answer 1

Failure to conceive following regular, unprotected sexual intercourse for 12 months

Question 2

How common is infertility?

Answer 2

Affects 1 in 6 couples

Question 3

What causes infertility?

Answer 3

30 % Male (sperm abnormalities and coital disorders)

25 % Tubal (occlusion and adhesions)

25 % Anovulatory

10 % Other

10 % Unexplained

Question 4

Tubal disease

Types, aetiologies, how to assess tubal status, treatment, prevention

Answer 4

Types: Occlusion (proximal or distal) and peritubal adhesions

Aetiologies: PID, endometriosis, pelvic surgery, mechanical

Assessing tubal status: HSG (hysterosalpingogram), Lap & dye

Treatment: Tubal surgery (adhesiolysis), IVF

Prevention: Preventing STIs, prevent iatrogenic adhesions, prevent PID ‘flare up’ through chlamydia screening

Question 5

Sperm abnormalities

Define: Oligo-, astheno-, terato-, azoo- and necro- zoospermia

Answer 5

Oligo- : Few

Astheno-: Impaired/weak

Terato-: Abnormal morphology

Azoo-: None

Necro-: Dead

Question 6

Sperm abnormalities

Outline the pre-testicular causes

Answer 6

HPT:

Hypogonadotrophic hypogonadism

Extra HPT:

Hyperprolactinema

Hypothyroidism

Obesity/DM

Androgenic sterid abuse

Question 7

Sperm abnormalities

Outline the testicular causes

Answer 7

Genetic: Y chromosome deletion, immotile cilia syndrome

Infective/traumatic

Environmental: Smoking, alcohol, occupational

Immunological

Congential: Cryptorchidism

Vascular: Torsion, varicocele

Iatrogenic: Chemo/radio- therapy

Idiopathic

Question 8

Sperm abnormalities

Outline the post-testicular causes

Answer 8

Obstructive: Epididymal

Epididymal hostility

Acessory gland infection: Seminal vesiculitis

Immunologic: Post-vasectomy

Question 9

Outline the management of infertility

Idiopathic (mild/moderate and severe) and known causes

Answer 9

• Idiopathic
  
  • Mild/moderate: IUI (intrauterine insemination)
  • Severe: ICSI (intracytoplasmic sperm injection) - a single sperm is injected directly into the cytoplasm of the oocyte
• Know cause
  
  • Stop exposure e.g. smoking
  • Endocrine treatment
  • Surgery for obstructions
  • Genetic counselling for genetic/chromosomal

Question 10

State the cervical factors which may lead to infertility (4 possible)

Answer 10

• Hormonal (defective response to oestrogen)
• Infection
• Damage
• Immunological (anti-sperm Igs)

Question 11

How may cervical factors of infertility be assessed and treated?

Answer 11

• Cervical mucus score
• pH
• Post-coital test
• Sperm-mucus penetration tests

Treatment

• IUI

Question 12

State the uterine factors which may cause infertility

Answer 12

• Asherman syndrome: Formation of scar tissue and adhesions due to uterine trauma
• Submucous fibroid
• TB
• Congential septum
• Hypoplastic uterus: Uterus fails to develop

Question 13

Outline the coital factors which may cause infertility

Answer 13

• Impotence: No erection or orgasm
• Vaginismus: Subconscious contraction of the vaginal muscles in anticipation of penestration
• Dyspareunia
• Retrograde ejaculation: Semen travels to the bladder rather than being ejected from the penis

Treatment includes psychosexual clinic and IUI