13 - Infertility

Question 1

What is the definition of subfertility?

Answer 1

Failure of conception in a couple having regular (once every 2-3 days) unprotected coitus for one year

Primary: never concieved

Secondary: have concieved in the past, even if abortion or ectopic, and struggling to concieve again

Question 2

If couples try to concieve for three years, what is the likelihood they will get pregnant in the next year?

Answer 2

25%

Question 3

What are some causes of subfertility in men?

Answer 3

- Pretesticular: HPG axis

- Testicular: sperm production or storage, e.g STIs, torsion

- Post testicular: e.g obstructive or erectile dysfunction

25% of cases reason for subfertility unknown

Question 4

What are the main causes of subfertility in both men and women?

Answer 4

Question 5

What are the three classes of subfertility causes in women?

Answer 5

• Tubular damage
• Uterine/peritoneal disorders
• Ovulatory disorders

Question 6

What are some ovulatory disorders causing subfertility?

Answer 6

Question 7

What are some uterine and peritoneal disorders that lead to subfertility in women?

Answer 7

- Fibroids

- Scarring or adhesions: PID, Asherman, endometriosis, abdominal surgery

- Abnormal uterus from issues with mullerian duct

Question 8

What are some mullerian duct development anomolies?

Answer 8

Question 9

What are some conditions that can cause tubal damage and lead to subfertility?

Answer 9

• Endometriosis
• Pelvic surrgery leading to damage
• Infection like chlamydia
• Ectopic pregnancy

Question 10

What are some important investigations to do when investigating subfertility in both men and women?

Answer 10

Question 11

What are some physical examinations you may do to investigate subfertility?

Answer 11

Question 12

What are some questions may you ask in a history to investigate subfertility?

Answer 12

Question 13

What is a hysterosalpinogram?

Answer 13

Can check patency of tubes by injecting dye into cervix, x-ray and see if dye spills into peritoneum

Question 14

What is some advice a GP can give to a couple who are having fertility issues, without referral?

Answer 14

REASSURE AND MOST WILL CONCIEVE IN A YEAR

Question 15

When should you refer a couple to fertility clinic?

Answer 15

- After 1 year of trying to concieve

• Sooner is woman is older (over 36) or known risk factors for infertility

Everyone entilited to investigations but not all to treatment

Question 16

What are three main types of treatment after diagnosis of subfertility made?

Answer 16

• Surgical
• Medical
• Assisted reproductive techniques

Question 17

What should you do for a woman if her partner has been given a chlamydia positive diagnosis?

Answer 17

Do not hold back - prescribe antibiotics before diagnosing her with NAAT

Question 18

What are the complications with PID?

Answer 18

• Peritonitis
• Tuboovarian abscess
• Ectopic pregnancy
• Changed position of uterus

Question 19

What is the most common causes of infertility in males and females?

Answer 19

Males: abnormal sperm

Females: anovulation (primary when never ovulate, secondary when used to ovulate but now can’t)