Infertility

Question 1

Infertility Definition

Answer 1

80% will conceive in 1 year if

• Woman under 40
• No contraception
• Regular intercourse ( every 2-3 days)

Question 2

Infertility Aetiology (Disorders of Ovulation)

Answer 2

• Three groups
• Group 1- hypothalamic pituitary failure
• Group 2- hypothalamic pituitary ovarian dysfunction (predominantly PCOS)
• Group 3- ovarian failure
• Pituitary tumours, Sheehans, Hyperprolactinaemia, cushings, chromosomal, premature ovarian failure

Question 3

Infertility Aetiology (tubes, uterus, cervix)

Answer 3

• Damage to tubes from infection (PID)
• STIs
• Female sterilisation
• Uterus infection (Ashermans)
• Deformity
• Endometriosis

Question 4

Infertility History

Answer 4

General health
-BMI, smoking, alcohol
Sexual
-Frequency of coitus, problems with coitus
PMHx
-Chemotherapy
-Systemic diseases (CKD, SLE, DM)
Medication

Question 5

Infertility Examination

Answer 5

• Look for PCOS
• Abdo exam
• Gynae exam

Question 6

Infertility Investigations

Answer 6

• Only if 1 year of no conception
• Should be systematic and led by clinical features
• Mid-luteal (7 days post ovulation) progesterone
• FSH and LH if ovulation not confirmed
• Rubella
• Tubal patency
• Ovarian reserve

Question 7

Infertility Early Referral Criteria

Answer 7

-Age ≥36, known cause, PHx, Ix show no chance of pregnancy with expectant management

Question 8

Infertility General Management

Answer 8

-Folic acid, frequency of intercourse, alcohol, smoking, weight

Question 9

Infertility Management Male

Answer 9

• No medications are effective

- Surgical correction where appropriate

Question 10

Infertility Management Female

Answer 10

Group 1 ovulation disorders
-Hypothalamic pituitary failure
-Keep BMI above 19, reduce exercise if excessive
-Pulsatile administration of GnRH to induce ovulation
Group 2 ovulation disorders
-Predominantly PCOS
-Clomifene citrate (anti-oestrogen)
-Metformin second line (can be used in combination)
-No more than six months of treatment
Group 3 ovulation disorders
-Ovarian failure
-If Hyperprolactinaemia; offer bromocriptine
Other
-Tubal and uterine surgery, treatment for endometriosis, ovarian hyper stimulation

Question 11

Infertility Assisted Conception

Answer 11

• Intrauterine insemination (IUI)
• Gamete intrafallopian disorder (GIFT)
• In vitro fertilisation (IVF)
• Intracytoplasmic sperm injection (ICSI)