Infertility :eggplant::fried_egg: (Workup (Begin w/ male :male_sign:…
Def: Couple has sex ≥1yr w/ intention of getting pregnant
most get pregnant @ yr 2. :calendar::calendar:
(where to put it, how to time it, not everyday:targeting ovulation)
blame the man first :male_sign::
(25% of infert is a guy problem), since there is cultural bias that women control pregnancy
Begin w/ male :male_sign::eggplant: problems:
maintaining and achieving erection
sperm flagellated: motile
sperm count good
:check::male_sign:Erection problem problem :checkered_flag:
Determine if psychogenic or organic:
nite time tumescence
Put a roll of stamps or tape on the penis ( :eyes:) and let guy fall asleep. Does the tape fall off?
:check: tape falls off: not organic.
Tx: Talk it out w/ therapist
Tx: PDE-5 inhibitors (viagra :pill:)
:check::Low sperm count :checkered_flag:
Tx: Artificial insemination
:pencil2: AI in order of complexity, efficacy, and cost
intrauterine insemination (IUI)
Concentrated sperm in turkey baster :turkey: straight into uterus (
not that effective
, but easy)
in vitro fertilization (IVF)
mom gets hormones, eggs harvested, mixed w/ sperm, reimplant zygote into mom.
Intracytoplasmic spermal injection
Like IVF, inject sperm into egg, take zygote implant in mom.
:green_cross::Guy is not the problem
:female_sign: Consider woman
At start/end of cycle, mucus is hard. Prevents infx, sterile uterus.
day 14 mucus should turn soft
couple should have sex around ovulation
: place mucus between slides and pull apart
soft mucus = stretches
hard mucus = breaks
< 6cm smush
no sperm under microscope
negative Fern sign
(reaction to estrogen)
: ripens mucus
positive Fern sign
Assess if ovulation is happening
Tx: Push ovulation w/
How Clomiphene works
:pencil2:Should be spike in temp at ovulation. Plateaus if pregnant (1º change)
good to determine when ovulation is happening, but not
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: Luteal phase (should be elevated)
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E/P Negative feedback
Clomiphene disinhibits GnRH
Pergonal = FSH/LH