Reproductive Health

Question 1

Infertility - male factors (history, examination, Ix)

Answer 1

History

• Duration of infertility
• Fertility in other relationships
• Medical and surgical history (inc testicular surgery, mumps)
• Medications
• Hx chemo or radiation
• Smoking, ETOH, drug use
• Occupational exposure
• Previous infertility testing and therapies

Examination

• Secondary sexual characteristics
• Genitalia (size, consistency of testes, epididymis and vas)

Investigations
- Semen analysis

Question 2

Infertility - female factors (history, examination, investigations)

Answer 2

History

• Duration of infertility
• Number and outcome of prior pregnancies
• Gynae history including PID, fibroids, surgery
• Menstrual history
• Changes in hair growth or body weight
• Medical and surgical history
• History of chemo or radiation
• Smoking, ETOH, substance use
• Occupational exposure
• Frequency of intercourse
• Previous infertility testing or therapies

Examination

• Secondary sexual characteristics
• Thyroid status
• Genitalia and breasts
• Vaginal and pelvic examination

investigations 
- Documentation of ovulatory function
- Pathology tests for women
● Day 3 FSH or estradiol, AMH
- Hysterosalpingogram (to test for tubal potency and uterine cavity)

Question 3

Preconception period

Answer 3

• Commencement of folate and iodine
• Advice on timing of intercourse (day 7-12)
• Ensure CST up to date
• Ensure immunity to rubella/varicella/hepatitis B
• Offer pre-conception genetic carrier screening
• Discuss importance of antenatal care
• Dietary, caffeine, alcohol advice during pregnancy