Infertility

Question 1

inability of a couple to conceive within 1 year

Answer 1

infertility

primary - never conceived
secondary - those who have conceived before

Question 2

intrinsic inability to achieve pregnancy

Answer 2

sterility

Question 3

probability of achieving a live birth in 1 menstrual cycle

Answer 3

fecundity

Question 4

likelihood of conception per month of exposure

Answer 4

fecundability

Question 5

what can cause infertility?

Answer 5

ovulatory dysfunction and tubal/peritoneal factors - females

male factor

Question 6

weight extremes are associated with infertility why?

Answer 6

anovulation

Question 7

what’s the modification first line for infertility in obese patients?

Answer 7

lifestyle modifications

Question 8

what do you test in males?

Answer 8

semen analysis
→ abnormal = repeat in >4 weeks to confirm findings and if still abnormal, requires further evaluation
→ normal = excludes males
Consider endocrine evaluation, US, genetic abnormalities

Question 9

when do you test ovarian reserve?

Answer 9

In women >35 who desire fertility
Elevation of FSH = low reserve
AMH is a reliable predictor

Question 10

what do you test in women?

Answer 10

ovulatory factors
-follicular pool
-ovarian reserve
In women >35 who desire fertility
Elevation of FSH = low reserve
AMH is a reliable predictor
-confirm ovulation: serum progesterone assay/1 wk before menses (>/=3), pelvic US, LH surge, basal body temperature

Pelvic exam, TVUS (fibroid) hysterosalpingogram (tubes/pelvis), laparoscopy with chromotubation is gold standard for tubal factor

Question 11

what’s the key to absent ovulation?

Answer 11

Elevated FSH + LH + low estradiol = ovarian insufficiency
Elevated LH with normal FSH = PCOS
Elevated prolactin = prolactinoma

Question 12

how do you treat infertility?

Answer 12

Obese: lifestyle modification
Folic acid supplement
Smoking cessation
Avoid vaginal lubricants - try mineral oil, canola oil, or hydroxyethylcellulose based lubricants

Treat endocrine abnormalities

Surgically - excision of ovarian tumors, endometriosis, IVF, laparoscopic procedures

Induction of ovulation can be performed with intrauterine insemination:
Clomiphene citrate
Limited to max of 6 cycles (increased risk of ovarian cancer if used >1 year)
Letrozole in PCOS
-Intrauterine insemination should only be performed when semen analysis is normal

Intracytoplasmic sperm injection

If azoospermia present → artificial insemination, surgical retrieval of sperm, or donor