Subfertility Flashcards
What is the definition of primary infertility?
Failure to conceive after 12 months of regular unprotected intercourse where no previous pregnancy has occurred
What is the definition of secondary infertility?
Failure to conceive after 12 months of regular unprotected intercourse where a previous pregnancy has occurred regardless of outcome
What are female causes of infertility?
Ovulatory disorders: PCOS, primary ovarian failure, hyperprolactinemia
Endometriosis
Tubal abnormalities: blockage from PID, previous surgery
Uterine abnormalities: Congenital (Mullerian defects), fibroids
Delayed return of regular ovulatory cycles post depo provera use
What are male causes of infertility?
Pretesticular: Kallman’s syndrome, pituitary disorder
Testicular: MUMPS, Klinefelter’s, Varicocele, toxins
Post-testicular: absent vas deferens (CF gene carrier), previous vasectomy
Idiopathic
What are combined causes of infertility?
Infrequent intercourse
Unknown
Age
What Ix would you do for infertility?
Rubella, varicella serology HIV, Hep B, Hep C Baseline hormone level: D2-3 LH, FSH, TSH, E2, prolactin, serum testosterone, SHBG Pelvic U/S Urine chlamydia screen Semen analysis
What general advice would you give regarding intercourse?
Have sex before you ovulate –> fertile window = 5 days leading up to ovulation
General advice is have sex every second day from day 8 until 18
How to monitor ovulation: diary, can check temp, cervical mucous, ovulation predictor kits (pee on a stick)
What do you do if the semen analysis is abnormal?
Repeat in 3 months
What do you do if the semen analysis showed azoospermia?
Ix for aetiology: male hormone panel and testicular U/S, and karyotype
How do you determine if ovulation is occurring?
Check mid luteal progesterone - usually day 21 (for a 28 day cycle)
What is the management for anovulation?
Clomifene (Selective oestrogen receptor modulator) Metformin Letrazole Ovarian drilling Gonadotropins
What do you do if still not pregnant after
3 months of clomifene?
Check tubal patency via hysterosalpingogram or laparoscopy and dye test
Options if can’t get pregnant
Keep trying IVF Donor egg/ sperm Surrogacy Adoption Accept no kids
What would you look for on examination of the female?
General inspection: hirsutism, acne, secondary sexual characteristics, BMI, syndromic features
Pelvic exam/ bimanual: uterine abnormalities ?tenderness/ immobility/ nodule
What would you look for on examination of the male?
General inspection: BMI, secondary sexual characteristics, syndromic features
Testicular exam: testicular volume ?is vas deferens palpable ?varicocele
