Infertility_Causes_and_Investigations_Flashcards
What percentage of couples are affected by infertility?
Infertility affects around 1 in 7 couples.
What percentage of couples who have regular sex will conceive within 1 year?
Around 84% of couples who have regular sex will conceive within 1 year.
What percentage of couples who have regular sex will conceive within 2 years?
Around 92% of couples who have regular sex will conceive within 2 years.
What are the major causes of infertility?
The major causes of infertility are male factor, unexplained, ovulation failure, tubal damage, and other causes.
What percentage of infertility cases are due to male factors?
30% of infertility cases are due to male factors.
What percentage of infertility cases are unexplained?
20% of infertility cases are unexplained.
What percentage of infertility cases are due to ovulation failure?
20% of infertility cases are due to ovulation failure.
What percentage of infertility cases are due to tubal damage?
15% of infertility cases are due to tubal damage.
What percentage of infertility cases are due to other causes?
15% of infertility cases are due to other causes.
What are the basic investigations for infertility?
The basic investigations for infertility are semen analysis and serum progesterone measurement.
When should serum progesterone be measured in a typical 28-day cycle?
Serum progesterone should be measured 7 days prior to the expected next period, which is day 21 in a typical 28-day cycle.
What does a serum progesterone level of < 16 nmol/l indicate?
A serum progesterone level of < 16 nmol/l indicates a need to repeat the test, and if consistently low, refer to a specialist.
What should be done if serum progesterone is consistently < 16 nmol/l?
If serum progesterone is consistently < 16 nmol/l, the patient should be referred to a specialist.
What does a serum progesterone level of 16-30 nmol/l indicate?
A serum progesterone level of 16-30 nmol/l indicates a need to repeat the test.
What should be done if serum progesterone is 16-30 nmol/l?
If serum progesterone is 16-30 nmol/l, the test should be repeated.
What does a serum progesterone level of > 30 nmol/l indicate?
A serum progesterone level of > 30 nmol/l indicates ovulation.
What are the key counselling points for couples trying to conceive?
The key counselling points for couples trying to conceive include taking folic acid, aiming for a BMI of 20-25, having regular sexual intercourse every 2 to 3 days, and receiving advice on smoking and drinking.
What is the recommended BMI range for women trying to conceive?
The recommended BMI range for women trying to conceive is 20-25.
How often should couples have sexual intercourse when trying to conceive?
Couples should have sexual intercourse every 2 to 3 days when trying to conceive.
What lifestyle advice should be given regarding smoking and drinking for couples trying to conceive?
Couples trying to conceive should receive advice on smoking and drinking, typically to reduce or eliminate these habits.
summarise infertility causes and investigation
Infertility: causes and initial investigations
Infertility affects around 1 in 7 couples. Around 84% of couples who have regular sex will conceive within 1 year, and 92% within 2 years
Causes
male factor 30%
unexplained 20%
ovulation failure 20%
tubal damage 15%
other causes 15%
Basic investigations
semen analysis
serum progesterone 7 days prior to expected next period. For a typical 28 day cycle, this is done on day 21.
Interpretation of serum progestogen
Level Interpretation
< 16 nmol/l Repeat, if consistently low refer to specialist
16 - 30 nmol/l Repeat
> 30 nmol/l Indicates ovulation
Key counselling points
folic acid
aim for BMI 20-25
advise regular sexual intercourse every 2 to 3 days
smoking/drinking advice
A 22 year-old woman and her male partner present to their GP as they been unsuccessfully trying to conceive for 4 months. Her periods have been regular and there is no obvious cause in her history. What is the most appropriate next step in her management?
Refer the patient for a laparoscopy and dye test
Address how the couple are having sexual intercourse and reassure the patient
Refer the patient for a basal temperature test
Refer the patient for a luteal phase progesterone test
Refer the patient’s partner for semen analysis
Address how the couple are having sexual intercourse and reassure the patient
A healthy couple can expect to take up to one year to conceive. Investigations are therefore usually performed after one year of regular attempts to conceive. It may however be prudent to address any mechanical reasons that are preventing the couple from conceiving, hence the sexual intercourse history.
A couple in their 20s come into their GP after failing to conceive despite having regular sexual intercourse for 6 months, and ask you for advice. What is the most appropriate course of action for you to take?
- Provide basal body temperature kit
- Order 21 day progesterone level
- Wait until they have been having regular intercourse for 12 months
- Wait until they have been having regular intercourse for 24 months
- Refer immediately to a specialist in infertility
Wait until they have been having regular intercourse for 12 months
It is recommended in this case that couples should have regular sexual intercourse for a period of 12 months. Regular sexual intercourse is defined as intercourse every 2-3 days.
Referral to a specialist is warranted after the couple have been having intercourse regularly for 12 months
Fertility testing in the couple is recommended after 12 months, and consists of semen analysis in the man and mid-luteal progesterone level in the female to confirm ovulation.
Basal body temperature kits have been shown to increase anxiety and have not been shown to be effective
Early referral should be considered when:
Female
Age above 35
Amenorrhoea
Previous pelvic surgery
Previous STI
Abnormal genital examination
Male
Previous surgery on genitalia
Previous STI
Varicocele
Significant systemic illness
Abnormal genital examination
NICE CKS
