Infertility Flashcards
(30 cards)
What is the definition of infertility?
Failure to conceive after 1 year of regular unprotected intercourse.
When should infertility be investigated earlier than 1 year?
If the woman is ≥35 years, or there are known risk factors (e.g., amenorrhea, pelvic inflammatory disease, chemotherapy, undescended testes).
Name the four main categories of infertility causes.
1) Female ovulatory, 2) Female tubal, 3) Male factor, 4) Unexplained.
Most common cause of female infertility?
Ovulatory disorders (e.g., PCOS).
Most common cause of male infertility?
Abnormal semen parameters (e.g., oligospermia, asthenozoospermia).
What is the first-line investigation for ovulation?
Serum progesterone on day 21 of a 28-day cycle (mid-luteal phase); value >30 nmol/L indicates ovulation.
What tests are used to assess tubal patency?
Hysterosalpingogram (HSG), Sonohysterography, or Laparoscopy with dye test.
What is the role of pelvic ultrasound in infertility?
To assess uterus, ovaries, and antral follicle count.
Which single test is sufficient for initial male fertility assessment?
Semen analysis (WHO 2021 reference values).
What are the WHO classes of ovulatory disorders?
Class I: Hypogonadotropic hypogonadism (e.g., anorexia, Kallmann syndrome)
Class II: Normogonadotropic anovulation (e.g., PCOS)
Class III: Hypergonadotropic hypogonadism (e.g., premature ovarian insufficiency)
What is the first-line treatment for anovulatory infertility in PCOS?
Letrozole (aromatase inhibitor), per recent guidelines.
What is the second-line treatment if Letrozole fails?
Gonadotropins or ovarian drilling.
When is IVF recommended?
After 2 years of unsuccessful attempts or earlier if tubal damage, severe male factor, or age >35 with reduced ovarian reserve.
What is intrauterine insemination (IUI) and its indications?
Sperm is inserted into the uterus around ovulation. Used in mild male factor, unexplained infertility, or donor sperm.
What BMI is associated with optimal fertility?
19–25 kg/m².
Name lifestyle factors that impair fertility.
Smoking, alcohol, caffeine >200mg/day, high BMI, underweight, stress.
What percentage of infertility is unexplained?
Approximately 25%.
What is the recommended treatment approach for unexplained infertility?
Expectant management for 1–2 years, then IVF.
Which endocrine disorders can affect fertility?
Hypothyroidism, hyperprolactinemia, diabetes mellitus, Cushing’s syndrome.
What is the target TSH in women planning pregnancy?
<2.5 mIU/L.
What is the management of WHO Class I ovulatory disorders (hypogonadotropic hypogonadism)?
Lifestyle changes (e.g., weight gain, stress reduction if functional cause)
Pulsatile GnRH therapy (if hypothalamic cause)
Gonadotropin therapy (FSH + LH) if GnRH is unavailable - FSH 75 IU IM daily from the second day of the period and hCG 5000 IU IM when follicle reaches 1.8 cm
Treat underlying cause (e.g., pituitary tumor, chronic illness)
What is the first-line and subsequent management of WHO Class II ovulatory disorders (e.g., PCOS)?
First-line: Letrozole (aromatase inhibitor) 5 mg daily for 5 days from D2
Second-line: Clomiphene citrate or gonadotropins 50 - 100 mg daily for 5 days from D2
Can be combined with hCG 5000 IU when 1.8 cm
Alternative: Laparoscopic ovarian drilling
Adjuncts: Weight loss, metformin (if insulin resistant), lifestyle changes
How is WHO Class III ovulatory disorder (hypergonadotropic hypogonadism) managed?
Oocyte donation with IVF is the only effective fertility treatment
Hormone replacement therapy (HRT) for symptom control and bone protection
Psychological support and counselling
What is the lower reference limit for semen volume in a normal seminal fluid analysis?
≥1.4 mL (WHO 2021)
