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Flashcards in SUBFERTILITY Deck (44)
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1

What percentage of couple trying to conceive will do so over the course of 1 year?

84%

2

What percentage of couple trying to conceive will do so over the course of 2 years?

92%

3

What is the definition of infertility?

Failure to conceive after regular unprotected sexual intercourse for 2 years

4

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.

5

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

6

In what percentage of couples struggling to conceive will the factor be only from the male?

22%

7

In what percentage of couples struggling to conceive will the factor be only from the female?

57%

8

In what percentage of couples struggling to conceive will the factor be only from both the male and the female?

21%

9

What is considered frequent enough sexual intercourse in order to have a good chance of conceiving?

Every 2-3 days

10

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

11

What are the female causes of infertility relating to ovulatory dysfunction?

Chronic systemic illness

Eating disorders

Obesity

PCOS

Hyperprolactinaemia

Hypo/hyperthyroidism

Cannabis use

NSAIDs

12

What are the female causes of infertility relating to tubal anomalies?

Pelvic inflammatory disease

Previous surgery

Previous ectopic pregnancy

Endometriosis

13

What are the female causes of infertility relating to problems with the uterus?

Fibroids

Uterine septae

Congenital anomaly

Asherman's syndrome

14

What are the female causes of infertility relating to coital dysfunction?

Vaginismus

Dyspareunia

15

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)

16

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

17

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)

18

What investigations should be done for a woman who presents as part of a subfertile couple?

MId-luteal phase progesterone

Pelvic ultrasound - structural abnormalities of uterus, ovarian cysts (PCOS), hydrosalpinx

Microbiology - screen for chlamydia

Hysterosalpingogram (HSG) or Hysterosalpingo contrast sonography (HyCoSy) - testing tubal patency

Dye guided laparoscopy can be used to find tubal occlusion (semen screen must have been done before this invasive procedure)

19

What investigations should be done for a man who presents as part of a subfertile couple?

Microbiology - screen for chlamydia

Semen analysis

20

What are the normal parameters in semen analysis?

Volume - 1.5-5 mls
Count - more than 20 million/ml
Progression - more than 50%
Normal forms - more than 30%

21

How should a man go about providing a semen sample for analysis?

3 days abstinence with at least a 72 hour history of good health

Sample should be examined within 1 hour of production.

Ideally two samples should be taken at least 12 hours apart

22

What about a semen analysis would suggest epididymo-orchitis?

Presence of more than 106 WBC

23

What do we define oligozoospermia as?

Less than 15 million/ml count

24

What do we define asthenozoospermia as?

Less than 32% motility

25

What do we define teratozoospermia as?

Less than 4%

26

What is the most common cause of male subfertility?

Oligo-terato-asthenospermia

27

How do you treat a woman who is subfertile due to anovulation?

Optimise general health - thyroid disease, diabetes

Weight loss if high BMI

Consider clomiphene (anti-oestrogen) to induce ovulation

Consider adding metformin if overweight

Consider ovarian drilling

28

What are the most important risks associated with clomiphene use?

Ovarian cancer

Multiple prenancy

29

How do you treat a woman who is subfertile due to uterine, tubal or pelvic problems?

Often removed prior to IVF

Hydrosalpinges are drained

Endometriosis can be operated on

Tubal blockage can be surgically removed

30

What is first line in the treatment of male factor infertility?

Intrauterine insemination (IUI)