Infertility history Flashcards
overall structure of hx & counselling
hx:
reassure with stats
HPC
menstrual & smear hx
gynae hx
obs hx
PMHs
DHx // allergies
partner hx
FHx
SHx
counselling:
causes
investigations
Mx options
opening stats
85% within a year
95% within 2 years
HPC infertility questions
length of problem
frequency UPSI
sex problems (dyspareunia)
previous relationships + fertility
babies from other partners
contraception
gynae hx questions
Unusual bleeding (menorrhagia, PMB, IMB, PCB) - onset, pattern, amount, clots, flooding
pain (dysmenorrhoea, dysparenuia, pelvic pain)
hair in unwanted places + unintended weight gain
unusual discharge
ovaries (bloating // early satiety)
menstrual hx + smear questions
1st day LMP
cycle length + regularity
menarche/menopause
up to date smear + abnormal?
PMH questions
STIs
gynae conditions/surgeries
autoimmune disease
DHx can cause infertility
ibuprofen/aspirin (prolonged)
chemo
steroids
spironolactone
anti-psychotic
partner questions
erectile dysfunction & performance issues
babies from other relationships
steroid use/smoking/alcohol
common causes of subfertility
male factors (semen) most common
ovulation problems (FSH/LH)
tubal problems (STI)
outline management steps
semen analysis: sperm no & quality, fresh sample after 3-5 days abstinence
progesterone 7 days before next cycle
FSH/LH within 1st 5 days
hysterosalpingogram or laproscopy & hydrotubation
key lifestyle/counselling points
folic acid
aim for BMI 20-25
advise regular sexual intercourse every 2 to 3 days
smoking/drinking advice
body temperature kits useful?
increase anxiety
have not been shown to be effective
