Subfertility Flashcards
Sequence of events and symptom analysis (check both partner’s responses)
Open question
Duration- how long have you been trying
Regular sex- how often
Types of sex- do you mean penetrative vaginal intercourse
Problems- any problems having sex eg. pain, bleeding, anxieties or fears
Systems review
See gyane systems review
Patients perspective
Feelings and effect on life
ICE
Background (check both partners responses)
PMH
Woman- miscarriages, PCOS, STI’s, gynae surgery, previous cancer (+treatment)
Man- mumps, STI, testicular torsion, vasectomy, trauma, previous cancer (+treatment)
NB- HAS THE MALE FATHERED CHILDREN PREVIOUSLY
DH (both, and any contraceptives used in the past, any drugs to help conception)
FH- anyone had difficulty conceiving a child
SH
General causes
Not having regular satisfactory penetrative sexual intercourse eg. dyspareunia, psychosexual issues, partner away for large periods of time, premature ejaculation before penetration
Recreational drugs, alcohol, smoking etc.
Female causes
Age
Being overweight or markedly underweight
Systemic conditions eg. SLE
Iatrogenic eg. pelvic surgery (adhesions) or chemo
Ovulation disorders- PCOS, hyperprolactinaemia, thyroid disorders, premature menopause, hypogonadotropic hypogonadism
Tubal disorders- PID, endometriosis
Uterine pathology- fibroids, uterine abnormalities
NB- if talking to female, do a screen for thyroid/PCOS/menopause/prolactinoma symptoms
Male causes
Testicular trauma Testicular torsion Bilateral undescended testicles Systemic conditions eg. CF Mumps with orchitis Gonorrhoea and chlamydia retrograde ejaculation after transurethral resection of the prostate (TURP)
Investigations
Female
Bedside- abdominal and bimanual exam
Bloods- serum progesterone on day 21, TFT, prolactin, oestrogen, testosterone, anti-mullarian
Imaging- Pelvic USS, hysterosalpingogram
Male
Bedside- testicular exam
Specialist- semen analysis
