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Subfertility (Investigations and Diagnosis (Examination = endocrine or…
Subfertility
Investigations and Diagnosis
Examination = endocrine or systemic disease, pelvic tumours e.g. fibroids, ovarian cysts, rigid hymen, vaginal atresia, small testicular size, varicoceles, epididymal cysts
Semen analysis (3 days abstinence); confirmed 3 times
Ovulation tests =
luteal
phase plasma progesterone level =/> 30nmol/ml;
LH surge
secretion detected 36h before ovulation with home testing kits
Tubal patency and pelvic normality assessed by ultrasonography, hysterosalpingography, hysteroscopy, laparoscopy
Kremer test / postcoital test = midcycle test, cervical mucus aspirated 12h after intercourse to check for sperm count and motility
Male: orchitis/STI
History = medical history, coital history, STI, menstrual history, previous pregnancy, mumps orchitis, occupation (heat, radiation, or tight pants), alcohol, substance abuse
Day 21 progesterone
Polycystic ovaries
Mild obesity, irregular menses or amenorrhea, and hyperandrogenism
Multiple cycsts in ovary
Cause not understood but maybe due to insulin resistance and hyperinsulinaemia = theca cells hyperactivity
Infrequent/absent ovulation; 2. Hyperandrogenism = hair growth, acne; 3. Polycystic ovarian morphology on ultrasound scan
Treatment = weight loss, ovulation induction with
clomiphene
, surgery, low does contraceptive pill, anti-androgens,
metformin
Treatment, Management, and Guidelines
IVF
Metformin improves chances
ISCU
12 cycles until IVF
Cytoplasmic sperm injection
Coitus timing = normal ovum survives for 24h, whereas sperm remains fertile for up to 72 hrs. Fertilisation therefore must occur
within 12 -24 hrs after ovum release
. It is therefore very important for couples to either have a
coital frequency of at least 3-4 times per week
, or, to time coitus with the LH surge.
Primary vs Secondary Subfertility
Primary infertility = couples who have not become pregnant after at least 1 year having sex without using birth control methods
Secondary infertility = couples who have been able to get pregnant at least once, but now are unable.
Ovulatory Disorders (25%)
Tubal Damage (20%)
Uterine/peritoneal disorders (10%)
Male factors (30%) i.e. sperm motility
Both female and male factors in 40% of cases where cause found.
Unexplained infertility (25%)
Subfertility = inability to conceive for 12 months after regular intercourse for 1 year >3x per week
Terms
Subfertility = inability to conceive for
12 months
after regular intercourse for 1 year >3x per week
Infertility
Prempak-C
Hormone replacement therapy to relieve symptoms of the menopause.
One type of tablet contains conjugated oestrogens and the other type contains norgestrel
Blocked tubes
Postcode Lottery