Infertility Flashcards
What is the definition of Infertility?
Failure to achieve pregnancy after 12 months or more of regular, unprotected intercourse
After what period of time should you evaluate a 35 yr old with infertility?
after 6 months
What percentage of couples in the US are affected by infertility?
15%
What is the approximate pregnancy rate (fecundability) for a normal couple?
25%
What percent of infertility can be attributed to male factor?
10 %
What percent of infertility can be attributed to Tubal or pelvic pathology?
35%
What percent of infertility can be attributed to ovulatory dysfunction?
15%
What percent of infertility is unexplained?
35%
What method of imaging should be used in patients with infertility likely secondary to tubal disease?
Hysterosalpingogram
What method of imaging should be used to assess for intracavitary causes of infertility?
Sonohysterogram
What is the rate of infection following hysterosalpingogram?
1.4 - 3.4%
If HSG demonstrates dilated fallopian tubes, what is the next best step in management?
Doxycycline 100 mg BID for 5 days
What test should you order to determine if ovulation has occurred and on what day of the menstrual cycle?
serum progesterone, day 20
What value of serum progesterone indicates ovulation has occured?
> 3 ng/ml
Ovarian reserve can be estimated by what 3 tests?
Cycle day 3 FSH, AMH, Antral follicle count
What level of cycle day 3 FSH indicates diminished ovarian reserve?
> 10 - 12
What antral follicle count indicates diminished ovarian reserve?
< 5 follicles in both ovaries
What level of AMH indicates diminished ovarian reserve?
< 0.7ng/ml
Endometriosis is found in what percentage of infertile women?
30 - 40%
What percent of reproductive age women have endometriosis?
5- 10%
Semen analysis: Normal Volume?
1.0 ml or more
Semen analysis: normal concentration?
15 million/ml or more
Semen Analysis: Normal Motility/progression?
40% or more with forward progression
Semen Analysis: Morphology?
> 4% with normal morphology
How long does spermatogenesis take?
3 months
What type of medication is Letrozole?
Aromatase inhibitor
What is the mechanism of action of Letrozole?
Inhibits production of Estrogen, thereby decreasing the negative feedback and increasing release of GnRH
What is the starting dose of Letrozole?
2.5 mg/day
On what cycle day should you start taking letrozole?
Cycle day 3
What is the max dose of letrozole that you can use?
7.5 mg daily
What type of medication is Clomiphene Citrate?
selective estrogen receptor modulator (SERM)
What is the mechanism of Clomphine Citrate?
blocks negative feedback of estrogen and increases gonadotropin secretion
What is the starting dose of clomiphene citrate?
50 mg
On what cycle day should you start taking clomid?
Cycle day 3
For how many days do you take clomid?
5 days
What is the max dose of clomid that you can use?
200 - 250 mg
What is the risk of multiple gestation when using clomid or letrozole?
10%
up to how many hours after ovulation can an egg be fertilized?
12 - 24 hrs
When do you use gonadotropins for ovulation induction?
Generally in IVF treatments for hyperstimulation
What is the national clinical pregnancy rate for IVF?
35%
in what percent of IVF cycles does ovarian hyper stimulation occur?
10%
