Infertility

What is infertility?

Inability to achieve a successful pregnancy despite regular, unprotected sex, without known etiology for either partner.

What are the duration requirements of infertility for women <35 vs >35?

< 35 years old: 12 months

> 35 years old: 6 months

What is primary infertility?

represents those who have never conceived

What is secondary infertility?

represents infertility after prior fertility

What is fecundability?

probability of achieving a pregnancy in ONE menstrual cycle; decreases with age due to declining quantity and quality of oocytes

What is subfertility?

delay in conceiving

What is sterility?

inability to conceive offspring

What HPI should be included for male infertility assessment?

Mumps, Vasectomy, Inguinal Hernia Repair, and Orchiectomy

What are some causes of male factor infertility?

endocrine/systemic disorders, testicular defects in spermatogenesis, sperm transport disorder, and idiopathic male infertility

What is a primary testicular defect leading to infertility?

Klinefelter syndrome (XXY)

What are acquired testicular defect leading to infertility?

varicocele, infection, toxic exposures

What are some sperm transport disorders affecting infertility?

Abnormal epididymis or vas deferens, ejaculatory duct disorders

How is semen analysis conducted?

2-7 days of sexual abstinence followed by 2 collected samples taken 1-2 weeks apart

What are some findings in a clinical semen analysis that could explain infertility?

- low sperm concentration

- absent sperm

- motility issues

- morphology issues

What is the overall systematic workup for male factor infertility?

1) semen analysis and basic labs

2) endocrine labs

3) scrotal US/MRI

4) Genetic Testing

What are the causes of female factor infertility?

Ovulatory disorders, fallopian tube disruption, and uterine abnormalities

What factors influence the quality and quantity of oocytes?

dependent on age, surgeries or injuries to the ovary

What are causes of ovulatory dysfunction?

Hypothalamic-pituitary dysfunction, medications, PMOS, Thyroid dysfunction, Hyperprolactinemia

What are the primary forms of ovulation induction medications?

Clomiphene (Clomid) and Letrozole (Femara - 1st line for PMOS)

What diagnostic is used to rule out tubal patency factors?

Hysterosalpingogram (HSG)

What conditions can cause occluded oviduct or fallopian tubes?

Untreated STI/PID, anatomical anomalies, hydrosalpinx, mucos, injury (ectopic pregnancy), or surgery (Salpingectomy)

What uterine abnormalities can lead to infertility?

congenital uterine anomalies, fibroids, endometriosis, pelvic adhesions, and cervix abnormalities

What is the overall systemic workup for male factor infertility?

1) Pelvic US and Labs

2) Endocrine Labs

3) HSG

4) Genetic Testing

How often should a couple have intercourse when trying to conceive?

once daily during window of fertility (5 days prior to ovulation and 1 day after)

What are the symptoms of ovulation?

"egg white" mucus, mittelschmerz breast tenderness and bloating that resolves with menses

What is In Vitro Fertilization (IVF)?

Controlled ovarian stimulation and oocyte retrieval with fertilization occuring in the lab

What are the characteristics of a Vasectomy?

Reversible (50-70% success) outpatient procedure to interrupt each vas deferens under local anesthesia

What are the characteristics of Bilateral Tubal Ligation (BTL)?

Permanent, non-reversible, procedure but does not stop menses

What are the differences in consent timing for BTL?

Medicaid > 30 days

Private < 72 hours