Subfertilty History

Question 1

What is subfertility? 😭

Answer 1

Inability to get pregnant after 1 year of regular intercourse (>2-3 a week)

Question 2

What is primary and secondary subfertility ?

Answer 2

Primary: female never conceived
Secondary: previously conceived

Question 3

What are the 5 general questions that would ask in a Sub-fertility history ?
😭

Answer 3

1. How long have you been trying to have a baby for ?
2. How often would you say you have sex in a week ?
3. Personal questions, and I hope you don’t mind me asking; do you or your partner have any problems during sex ? Any dyspaenuria/ vaginismus
4. Have you/partner ever had children before ?
5. Have you tried anything to help you with having children ? Eg treatments

Question 4

After general questions, what are the 3 things that you will ask the female that will be part of the fertility history? 😭

Answer 4

Menstrual irregularities (PCB/IMB)+ Weight (personal question)+ gynae Hx (MOSC)

Question 5

For the menstrual history what are you mainly focusing on ?

Answer 5

Dysmenorrhea(PID/endometritis), HMB

Question 6

Remember to be sensitive when taking a previous obstetric history. What questions are you asking about ?

Answer 6

Previous ectopic pregnancy and miscarriages or terminations

Question 7

What should you remember to ask about in a sexual history regarding subfertility ?

Answer 7

History of STIs and STI screen

Question 8

What is the aetiology of sub-fertility ? (5)

Answer 8

1.Anovulation (35%); 2. Male fertility (25%); 3.Tubal pathology: (25%): no fertilisation or implantation. 4. Unexplained (30%); 5. Coital dysfunction (5%)

Question 9

What medication and drug can reduce the number of ovulating cycles ?

Answer 9

NSAIDs and cannabis

Question 10

What additional things will you do to complete a subfertility history ? (2)

Answer 10

Take a history from the partner

Measure the BMI of female and partner

Question 11

What 2 examinations will you do on the female ?

Answer 11

Abdominal and bimanual vaginal examination

Question 12

What examination will you do for the Male ?

Answer 12

Testicular examination

Question 13

What are the 3 parts the investigations can be divided into ?

Answer 13

1. Ovulation problems, 2. Male fertility; 3. Tubal damage

Question 14

What 3 investigations will you do for anovulation problems?

Answer 14

1. Pelvic USS; 2. Mid-literal phase progestorone at day 21; 3. Hormones (6): FSH, LH, AMH, testosterone, prolactin and TSH

Question 15

What investigation will you do for Male fertility?

Answer 15

Semen analysis

Question 16

What will you do for suspected tubal damage ?

Answer 16

Laparoscopy and dye/hysterosalpingogram

Question 17

What does the treatment of subfertilty involve ?

Answer 17

1. Lifestyle changes; 2.Treat underlying cause if fails Or unexplained: IVF