Infertility
From Ganfyd
Web Resources for Infertility
Relevant Clinical Literature
UK Guidance
Other Wikis
Medpedia on Infertility (Less technical, good quality control)
Wikipedia on Infertility (Less technical, ? quality control)
It is important to establish whether a couple is actually infertile (or sub-fertile). A woman has a 25-30% chance of conceiving per menstrual cycle, which works out to approximately 80% of couples conceiving after 12 months, 90% after 18 months. It is worth ensuring that adequate sexual intercourse has been happening for this length of time before considering the couple to have fertility problems.
Contents |
Causes
 | Distinguish primary and secondary infertility, with the same partner and a different one |
- anovulation -21%
- male factor - 24%
- obstructive azoospermia
- testicular failure
- congenital abnormalities
- sexual factors
- varicocele
- endocrine disturbances
- Loss of DNA integrity[1][2]
- unexplained -27%
- tubal factors - 14%
- endometriosis - 6%
- sexual dysfunction - 6%
- mucus hostility - 3%
- ?immunological - <5% male factor cases
Initial consultation
- age - 50% over 40s infertile
- duration of infertility
- previous fertility with other partners
Male
History
- episodes of testicular pain / swelling
- infection
- trauma
- testicular or groin injury
- underwear
- tobacco, alcohol, cannabis
- chemotherapy
- orgasm problems
- retrograde ejaculation after TURP
Examination
- abdominal
- external genitalia
- hypospadias
- testicular size
- vas deferens
- inguinal hernias
- varicocele
Investigation
- semen analysis - at least 2 specimens
- volume > 2ml
- pH 7.2 - 8.0
- sperm concentration > 20 million per ml
- motility >60% forward progressive
- morphology > 70% normal forms
- white count < 1 million / ml
- FSH - if low sperm count
- low FSH - pituitary problem/tumour
- normal FSH - blocked vas
- high FSH - primary testicular failure
Treatment
- Surgical reconstruction of blocked vas
- Intrauterine insemination
- In vitro fertilisation
- Intracytoplasmic sperm injection (ICSI)
Female
History
- contraception
- incidence of separation
- frequency of coitus
- dyspareunia
- menstrual history / cycle
- features of polycystic ovary disease
- irregular periods
- hirsutism
- acne
- features of hyperprolactinaemia
- thyroid dysfunction
- pelvic inflammatory disease
- general medical history
- past gynae history
- previous miscarriage
- sexual history
Examination
- general
- pelvic
Investigation
- rubella immunity
- FSH - raised >35 or not ovulating
- LH, prolactin
- oestrogen
- ?TFTs
- day 21 progesterone (or 7/7 before menstruation)
- serial scanning
- hysterosalpingogram
- laparoscopy
- hysteroscopy
- falloscopy
- cervical factors
- post-coital test
- in-vitro mucus penetration test
Treatment
- Endometriosis
- Ovulation induction
- clomifene
- gonadotrophins
- Assisted conception
- In vitro fertilisation (IVF)
- Intracytoplasmic sperm injection (ICSI)
- Tubal surgery
- (<30 % chance of becoming pregnant)
- 6-9 month window after operation for best fertility
References
- ↑ Aitken RJ, De Iuliis GN. Origins and consequences of DNA damage in male germ cells. Reproductive biomedicine online. 2007 Jun; 14(6):727-33.
- ↑ Aitken RJ, De Luliis GN. Value of DNA integrity assays for fertility evaluation. Society of Reproduction and Fertility supplement. 2007; 65:81-92.
- ↑ Satta A, Stivala A, Garozzo A, Morello A, Perdichizzi A, Vicari E, Salmeri M, Calogero AE. Experimental Chlamydia trachomatis infection causes apoptosis in human sperm. Human reproduction (Oxford, England). 2006 Jan; 21(1):134-7.(Link to article – subscription may be required.)
- ↑ Perdichizzi A, Nicoletti F, La Vignera S, Barone N, D'Agata R, Vicari E, Calogero AE. Effects of tumour necrosis factor-alpha on human sperm motility and apoptosis. Journal of clinical immunology. 2007 Mar; 27(2):152-62.(Link to article – subscription may be required.)
