infertility

Question 1

Investigation and referral for infertility should be initiated after the couple has been trying to conceive without success for

Answer 1

12 months.

Question 2

Causes

Answer 2

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

Question 3

Initial investigations, often performed in primary care:

Answer 3

Body mass index (BMI) (low could indicate anovulation, high could indicate PCOS)
Chlamydia screening
Semen analysis
Female hormonal testing (see below)
Rubella immunity in the mother

Question 4

Female hormone testing involves:

Answer 4

Serum LH ( PCOS) and FSH ( poor ovarian reserve) on day 2 to 5 of the cycle
Serum progesterone on day 21
Anti-Mullerian hormone
Thyroid function tests when symptoms are suggestive
Prolactin (hyperprolactinaemia is a cause of anovulation) when symptoms of galactorrhea or amenorrhoea

Question 5

secondary care investigation

Answer 5

ultrasound
hysterosalpingogram
laparoscopy and dye

Question 6

Management

Answer 6

anovulation - WL, Clomifene, letrozole, metformin,
IVF
surgical sperm retrieval/ intra uterine insemination

Question 7

Key counselling points

Answer 7

folic acid
aim for BMI 20-25
advise regular sexual intercourse every 2 to 3 days
smoking/drinking advice

Question 8

what progesterone level indicates ovulation

Answer 8

> 30