Fertility

Question 1

Causes of infertility

Answer 1

Sperm problems 30%
Ovulation problems 25%
Tubal problems 15%
Uterine problems 10%
Unexplained 20%

40% have mixed male and femal

Question 2

General advice for conception

Answer 2

Woman taking 400mcg folic acid
Aim for healthy BMI
Avoid smoking and drinking
Reduce stress
Intercourse every 2-3 days
Avoid timing intercourse - increased stress and pressure

Question 3

Investigations in infertility primary care

Answer 3

BMI
Chlamydia
Semen analysis
Female hormonal testing
Rubella immunity

2dry care
Ultrasound
Hysterosalpigogram
Laparoscopy

Question 4

Pre-testicular causes of infertility

Answer 4

Low Testosterone - pathology at pituitary or hypothalamus
Suppression due to stress
Kallman syndrome

Question 5

Testicular causes of infertility

Answer 5

Damage - mumps, undescended, trauma, radiotherapy, chemotherapy, cancer
Genetic - klinefelter, ychromosome deletions, sertoli cell only syndrome, anorchia

Question 6

Post testicular causes of infertility

Answer 6

Obstruction
Damage to vas deferens - trauma surgery cance
Ejaculatory duct obstruction
Retrograde ejaculation
Scarring - epididymitis
Absence of vas
Young syndrome

Question 7

Investigations in male infertility

Answer 7

Semen analysis Hormonal analysis
Genetic testing
Ultrasound
MRI
Vasography
Testicular biopsy

Question 8

Management of male infertility

Answer 8

Surgical sperm retrieval
Surgical correction
Intra-uterine insemination
ICSI
Donor insemination