Infertility

Question 1

What are the top 5 causes of infertility?

Answer 1

• anovulatory infertility (PCOS) 25%
• Tubal disease 20%
• Endometriosis (10%)
• Male factor (30%)
• Unexplained

40% of couples with difficulty conceiving will have both male and female component.

Question 2

What is sub fertility defined as?

Answer 2

• refer to sub fertility clinic after 1 year of unprotected vaginal sex and not conceiving.

Question 3

what are the main social factors affecting sub fertility?

Answer 3

• maternal age >35
• smoking
• coital frequency (2-3x per week)
• alcohol
• female body weight
• Drugs: NSAIDs, chemotherapy, sulphasalazine and androgen injections affect sperm

Question 4

What are the anovulatory causes of infertility?

Answer 4

• Pituitary:
• hyperprolactinaemia has an inhibitory effect on all pituitary hormones
• hypopituitarism (global)
• hypothalamic: Wallmans syndrome (GnRH deficiency, associated with anosmia)
• PCOS

Question 5

what tubal problems may arise?

Answer 5

• PID (chlamdia or endometriosis)
• fibroids or polyps in the way
• previous abdominal or pelvic surgery (Ashermans syndrome)
• ruptured ectopic

Question 6

what is male sub fertility caused by usually?

Answer 6

• idiopathic (50%)
• varicocele (12%)
• infection (7%)
• immunological (3%)

Question 7

define these terms:

• azoospermia
• oligospermia
• asthenozoospermia
• teratozoospermia

Answer 7

• no traceable sperm
• <15 million/ ml sperm in ejaculate
• reduced motility
• abnormal morphology

Question 8

what may cause obstructive azoospermia?

Answer 8

• blockage, so no sperm can come out
  Causes:
• infection
• congenital absence of vas deferens (cystic fibrosis)
• vasectomy
• Low sperm production due to low testosterone/ FSH/LH

Question 9

what investigations would you perform in a female?

Answer 9

• FSH (+/- LH) and oestrogen at days 1-5, (should be low) confirms ovarian reserve
• rubella and chlamydia serology
• If PCOS suspected then pelvic ultrasound

Question 10

how could you check for tubal dysfunction?

what endometrial factors might inhibit embryo attachment?

Answer 10

• hysterosalpingogram
• endometriosis
• fibroids
• polyps
• ruptured ectopic