Infertility_Causes_and_Investigations_Flashcards

Question 1

What percentage of couples are affected by infertility?

Answer 1

Infertility affects around 1 in 7 couples.

Question 2

What percentage of couples who have regular sex will conceive within 1 year?

Answer 2

Around 84% of couples who have regular sex will conceive within 1 year.

Question 3

What percentage of couples who have regular sex will conceive within 2 years?

Answer 3

Around 92% of couples who have regular sex will conceive within 2 years.

Question 4

What are the major causes of infertility?

Answer 4

The major causes of infertility are male factor, unexplained, ovulation failure, tubal damage, and other causes.

Question 5

What percentage of infertility cases are due to male factors?

Answer 5

30% of infertility cases are due to male factors.

Question 6

What percentage of infertility cases are unexplained?

Answer 6

20% of infertility cases are unexplained.

Question 7

What percentage of infertility cases are due to ovulation failure?

Answer 7

20% of infertility cases are due to ovulation failure.

Question 8

What percentage of infertility cases are due to tubal damage?

Answer 8

15% of infertility cases are due to tubal damage.

Question 9

What percentage of infertility cases are due to other causes?

Answer 9

15% of infertility cases are due to other causes.

Question 10

What are the basic investigations for infertility?

Answer 10

The basic investigations for infertility are semen analysis and serum progesterone measurement.

Question 11

When should serum progesterone be measured in a typical 28-day cycle?

Answer 11

Serum progesterone should be measured 7 days prior to the expected next period, which is day 21 in a typical 28-day cycle.

Question 12

What does a serum progesterone level of < 16 nmol/l indicate?

Answer 12

A serum progesterone level of < 16 nmol/l indicates a need to repeat the test, and if consistently low, refer to a specialist.

Question 13

What should be done if serum progesterone is consistently < 16 nmol/l?

Answer 13

If serum progesterone is consistently < 16 nmol/l, the patient should be referred to a specialist.

Question 14

What does a serum progesterone level of 16-30 nmol/l indicate?

Answer 14

A serum progesterone level of 16-30 nmol/l indicates a need to repeat the test.

Question 15

What should be done if serum progesterone is 16-30 nmol/l?

Answer 15

If serum progesterone is 16-30 nmol/l, the test should be repeated.

Question 16

What does a serum progesterone level of > 30 nmol/l indicate?

Answer 16

A serum progesterone level of > 30 nmol/l indicates ovulation.

Question 17

What are the key counselling points for couples trying to conceive?

Answer 17

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.

Question 18

What is the recommended BMI range for women trying to conceive?

Answer 18

The recommended BMI range for women trying to conceive is 20-25.

Question 19

How often should couples have sexual intercourse when trying to conceive?

Answer 19

Couples should have sexual intercourse every 2 to 3 days when trying to conceive.

Question 20

What lifestyle advice should be given regarding smoking and drinking for couples trying to conceive?

Answer 20

Couples trying to conceive should receive advice on smoking and drinking, typically to reduce or eliminate these habits.

Question 21

summarise infertility causes and investigation

Answer 21

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

Question 22

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

Answer 22

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.

Question 23

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

Answer 23

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

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