SUBFERTILITY Flashcards
What percentage of couple trying to conceive will do so over the course of 1 year?
84%
What percentage of couple trying to conceive will do so over the course of 2 years?
92%
What is the definition of infertility?
Failure to conceive after regular unprotected sexual intercourse for 2 years
What is the difference between primary and secondary subfertility?
Primary refers to couple who have never had a previous pregnancy, whereas secondary refers to those who have had a previous pregnancy.
At what point do we investigate couples who are having trouble conceiving?
After 1 year of trying.
Investigation may be needed earlier if history reveals risk factors such as infection, menstrual irregularities or where female is over 35 years old
In what percentage of couples struggling to conceive will the factor be only from the male?
22%
In what percentage of couples struggling to conceive will the factor be only from the female?
57%
In what percentage of couples struggling to conceive will the factor be only from both the male and the female?
21%
What is considered frequent enough sexual intercourse in order to have a good chance of conceiving?
Every 2-3 days
What key things should be asked about in a history from a women in a subfertile couple?
Duration of subfertility
Frequency of intercourse
Coital problems - female vaginismus, dyspareunia
Previous pregnancies, outcomes and modes of delivery, including ectopic.
Past gynae history - menorrhagia (fibroids), dysmenorrhoea (endometriosis), Asherman’s (adhesions), previous infections, oligo/ameno-rrhoea
Past medical history - chronic (renal/thyroid), eating disorders
Drug history - previous contraceptive use, regular use of NSAIDs, folic acid supplements
Social - smoking and alcohol, exercise and weight loss
What are the female causes of infertility relating to ovulatory dysfunction?
Chronic systemic illness
Eating disorders
Obesity
PCOS
Hyperprolactinaemia
Hypo/hyperthyroidism
Cannabis use
NSAIDs
What are the female causes of infertility relating to tubal anomalies?
Pelvic inflammatory disease
Previous surgery
Previous ectopic pregnancy
Endometriosis
What are the female causes of infertility relating to problems with the uterus?
Fibroids
Uterine septae
Congenital anomaly
Asherman’s syndrome
What are the female causes of infertility relating to coital dysfunction?
Vaginismus
Dyspareunia
What key things should be asked in a history from a man in a subfertile couple?
Erectile/ejaculatory dysfunction
Past surgical history - inguinal hernia repair, undescended testes, testicular torsion, bladder neck surgery
Past medical history - cystic fibrosis (vas deferens obstruction), epididymo-orchitis (from STI), post-pubertal mumps (orchitis), chronic medical conditions (eg renal and diabetes)
Drug history
Social history - smoking, alcohol, occupational history (driving raises temp)
What drugs can lead to male subfertility?
Anabolic steroids Cannabis Cocaine Sulfasalazine (IBD) Colchicine (gout) Nitrofurantoin (Abx) Tetracycline (Abx) Alpha blockers - interere with ejaculation Beta blockers
What basic blood test is a first line investigation and should be done for a woman who presents as part of a subfertile couple?
Mid-luteal phase progesterone: performed a week before next period is due (normally day 21)