Infertility
Epidemiology
Aetiology
Female
Male
History
Female
Male
Both
Examination
Female
Male
Investigations
Female:
Male
NOTE: examine 2 specimen 3 mo apart
Management
Source
OHCS 8th Ed 2009
Dr Zvi Graubard 2014
- N: 84% conceive in 1y, 92% 2y with regular intercourse (3/w)
- Female causes ~70%
Aetiology
Female
- Unexplained (27%) --> 60-70% conceive in 3y
- Anovulation (21%)
- Tubal blockage (14%) (PID, ectopic pregnancy)
- Endometriosis (6%)
- Hostile mucus (3%)
- Systemic (Age, autoimmune)
- Endocrine (corpus luteum def, anrupture of follicle, PCOS, thyroid, DM)
- Uterine (endometriosis, adenomyosis, fibroids, adhesions)
- Cervical (mucus, stenosis, lubricant - KY gel is spermicidal)
Male
- Sperm (24%)
- Erectile dysfunction (4%)
- Obesity (produce 60% less seminal fluid, 40% more abnormal sperm)
- Endocrine
History
Female
- Menstrual hx, obstetric hx, gynae hx, surg hx, meds/drugs
Male
- Puberty, previous fatherhood, PMHx (adult mumps, STI), surg hx
Both
- Time/ regularity of intercourse, stress
Examination
Female
- Abdmomen/ pelvic
Male
- Testicular development, penile anomalies, varicoceles
Investigations
Female:
- Day 21 progesterone (check ovulation)
- Day 5 FSH (++ = poor response to ovarian stimulation = 1o ovarian failure)
- Day 5 LH (PCOS)
- TFT, prolactin, BSL
Male
- Sperm: N = Vol >2ml, >20mil/ml, >50% motile within 1h post ejaculation, >30% normal form
NOTE: examine 2 specimen 3 mo apart
Management
- SNAP
- Lose weight
- Reduce stress
- Female to start folic acid 0.4mg
- Tubal closure/ >40y: IVF
- Cervical mucus: artificial insemination (if >40y, skip this, do IVF)
- Anovulation: Clomifene (may cause endometrial ca)
Source
OHCS 8th Ed 2009
Dr Zvi Graubard 2014