Infertility

Question 1

What is infertility and how common is it?

Answer 1

Infertility is the inability to conceive after regular unprotected intercourse, affecting around 1 in 7 couples.

Question 2

What proportion of couples conceive naturally within 1 and 2 years?

Answer 2

Approximately 84% conceive within 1 year and 92% within 2 years.

Question 3

What is the most common cause of infertility overall?

Answer 3

Male factor infertility, accounting for around 30% of cases.

Question 4

What proportion of infertility cases are unexplained?

Answer 4

Approximately 20% of cases.

Question 5

What proportion of infertility is due to ovulation failure?

Answer 5

Around 20%.

Question 6

How commonly is tubal damage responsible for infertility?

Answer 6

Tubal damage accounts for approximately 15% of cases.

Question 7

What proportion of infertility is due to other causes?

Answer 7

Around 15%.

Question 8

What are the two basic initial investigations recommended for infertility?

Answer 8

Semen analysis and serum progesterone measurement.

Question 9

Why is semen analysis an essential first-line investigation?

Answer 9

Because male factor infertility accounts for the largest proportion of infertility cases.

Question 10

When should serum progesterone be measured to assess ovulation?

Answer 10

Seven days before the expected next menstrual period.

Question 11

On which day is serum progesterone measured in a 28-day cycle?

Answer 11

Day 21.

Question 12

What does a serum progesterone level below 16 nmol/L indicate?

Answer 12

Likely anovulation; repeat the test and refer to a specialist if persistently low.

Question 13

How should a serum progesterone level between 16 and 30 nmol/L be interpreted?

Answer 13

Equivocal result; the test should be repeated.

Question 14

What does a serum progesterone level greater than 30 nmol/L indicate?

Answer 14

Ovulation has occurred.

Question 15

What lifestyle advice should be given regarding folic acid in infertility?

Answer 15

Advise folic acid supplementation to reduce the risk of neural tube defects.

Question 16

What BMI range should be advised when counselling couples about fertility?

Answer 16

Aim for a BMI between 20 and 25.

Question 17

What advice should be given about frequency of sexual intercourse?

Answer 17

Regular intercourse every 2–3 days to optimise chances of conception.

Question 18

What advice should be given regarding smoking and alcohol?

Answer 18

Advise smoking cessation and limiting alcohol intake to improve fertility outcomes.