Infertility

Question 1

What is the female reproductive cycle?

Answer 1

Menstrual phase
Follicular phase
Ovulation
Luteal phase

Question 2

What is key about a history and examination of a sub fertile couple?

Answer 2

To determine: are eggs and sperm available, can they meet, can embryo implant.

Female
History: duration of infertility, previous contraception, previous fertility, previous pregnancies, menstrual history, medical and surgical history, previous investigations, psychological assessment
Exam: weight, height, BMI, fat and hair distribution, galactorrhoea, abdo exam, pelvic exam

Male:
History: testicular descent, shaving changes, body hair, mumps, stds, variocele repair, vasectomy, previous fertility, alcohol, smoking, steroid use, chemo, radiotherapy, recreational drugs, sex drive, frequency of intercourse, medical and surgical history
Exam: weight, height, BMI, fat and hair distribution, abdominal and inguinal exam, genital exam

Question 3

What investigative pathways can you go down in male and female infertility?

Answer 3

Female

• rubella immunity
• chlamydia
• TSH
• mid luteal progesterone if reg menses
• day 1-5 FSH, LH, PRL, TSH, testosterone if irreg menses
• USS
• ovulation testing
• tubal patency testing

Male
- semen analysis

Question 4

What treatment options are available for infertility?

Answer 4

Female factor problem
Ovulatory disorders: treat underlying cause, weight loss or gain eg BMI >18 and <35, ovulation induction using clomifene, gonadotrophins

Tubal factor and endometriosis: surgery for hydrosalpinges before in vitro fertilisation treatment

Males factor problem: 
IVF/ICSI
Intrauterine insemination
Surgery eg sperm retrieval 
Donor insemination

Question 5

How does assisted conception work?

Answer 5

IVF: eggs harvested from ovary, fertilised in lab with sperm, embryos undergo number of cell divisions, transferred to the womb

Intracytoplasmic sperm injection: injection of mature eggs with single sperm, incubated overnight, transferred to uterus