13: Infertility

Question 1

What is normal fecundity?

Answer 1

The capacity to conceive measured by a monthly probability of conception.

Average 20% per month (takes couples 3 months on avg)

Question 2

Lifestyle causes of infertility

Answer 2

Smoking, alcohol, weight, exercise, medication

Question 3

Hx and Exam for infertile couple

Answer 3

General: age, occupation/envrionment, folate, smoking, drugs, alcohol

Specific symptoms: acne, hirsutism, dysmenorrhoea

Sexual practice: how much, how often, timing in cycle

Obs hx: pregnancies, miscarriages
Gynae hx: PCOS, endo, STi, pelvic surgery

Question 4

Female Ix for infertility

Answer 4

Lab
- Blood: hormone profile incl. day 21 progesterone, testosterone, FSh, LSH, LH:FSH ratio, TFT, prolactin

Imaging

• USS
• Laparoscopy/hysterosalpingogram

Question 5

Male ix for infertility

Answer 5

Semen analysis

Bloods: FSH, testosterone, karyotyping

Question 6

What are the sx and signs of PCOS?

Answer 6

Common: menstrual irregularities, hirsutism, overweight, acne, HTN

Question 7

Dx of PCOS

Answer 7

• Evidence of oligo or anovulation
• Increased androgens e.g. hirsutism
• PCO on USS

Question 8

Long term cx of PCOS

Answer 8

• CVS: dyslipidaemia, metabolic syndrome
• T2DM
• NAFLD
• Pregnancy: GDM, HTN, PET, PTL