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Questions and Answers
What is the general definition of infertility?
What is the general definition of infertility?
What percentage of couples are expected to conceive within 1 year?
What percentage of couples are expected to conceive within 1 year?
What term refers to the probability that a single cycle results in pregnancy?
What term refers to the probability that a single cycle results in pregnancy?
What factor does NOT contribute to the decline in birth rates over the last 200 years?
What factor does NOT contribute to the decline in birth rates over the last 200 years?
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What is the crude birth rate in the US in 2001?
What is the crude birth rate in the US in 2001?
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After how many months of exposure does the likelihood of pregnancy reach 57%?
After how many months of exposure does the likelihood of pregnancy reach 57%?
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At what point is evaluation for infertility recommended?
At what point is evaluation for infertility recommended?
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What percentage of couples is expected to be pregnant after 2 years of trying?
What percentage of couples is expected to be pregnant after 2 years of trying?
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What is fecundity in relation to infertility?
What is fecundity in relation to infertility?
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Which factor is most likely to affect male infertility?
Which factor is most likely to affect male infertility?
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What is the significance of measuring Anti-Mullerian Hormone (AMH) levels in women over 35 years of age?
What is the significance of measuring Anti-Mullerian Hormone (AMH) levels in women over 35 years of age?
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Which of the following is NOT typically used to confirm ovulation?
Which of the following is NOT typically used to confirm ovulation?
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What characteristic of cervical mucus is NOT evaluated during a postcoital test?
What characteristic of cervical mucus is NOT evaluated during a postcoital test?
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What is the primary purpose of Hysterosalpingography (HSG)?
What is the primary purpose of Hysterosalpingography (HSG)?
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Which hormone level is considered consistent with lack of ovulation?
Which hormone level is considered consistent with lack of ovulation?
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Which of the following factors can contribute to uterine abnormalities impacting fertility?
Which of the following factors can contribute to uterine abnormalities impacting fertility?
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Which factor contributes to about 30-40% of infertility cases?
Which factor contributes to about 30-40% of infertility cases?
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What does Mittelschmerz refer to in the context of ovulation?
What does Mittelschmerz refer to in the context of ovulation?
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What is the importance of measuring serum progesterone concentration in assessing ovulatory function?
What is the importance of measuring serum progesterone concentration in assessing ovulatory function?
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During which phase of the menstrual cycle is the serum progesterone assay typically performed?
During which phase of the menstrual cycle is the serum progesterone assay typically performed?
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Which of the following history elements is NOT typically included in a female infertility evaluation?
Which of the following history elements is NOT typically included in a female infertility evaluation?
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Which imaging method has a sensitivity of approximately 65% for evaluating uterine cavity conditions?
Which imaging method has a sensitivity of approximately 65% for evaluating uterine cavity conditions?
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Menstrual history helps evaluate which aspect of infertility?
Menstrual history helps evaluate which aspect of infertility?
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Which screening test is specifically recommended for Rh-negative women?
Which screening test is specifically recommended for Rh-negative women?
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What percentage of infertility cases is classified as unexplained?
What percentage of infertility cases is classified as unexplained?
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Which clinical sign may indicate androgen excess during a physical examination?
Which clinical sign may indicate androgen excess during a physical examination?
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What is the role of transvaginal ultrasound in assessing infertility?
What is the role of transvaginal ultrasound in assessing infertility?
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Which of the following is NOT considered a potential male factor in infertility?
Which of the following is NOT considered a potential male factor in infertility?
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Which agent is screened for during infertility evaluation that reflects possible infectious causes?
Which agent is screened for during infertility evaluation that reflects possible infectious causes?
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Which of the following factors is NOT listed as a modifiable risk factor for sexual dysfunction?
Which of the following factors is NOT listed as a modifiable risk factor for sexual dysfunction?
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What percentage of women in the obese population may experience sexual dysfunctions according to the provided data?
What percentage of women in the obese population may experience sexual dysfunctions according to the provided data?
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Chronic smoking has which of the following effects related to sexual health?
Chronic smoking has which of the following effects related to sexual health?
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What is one potential psychological effect of sexual dysfunction?
What is one potential psychological effect of sexual dysfunction?
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Which condition is most directly indicated to improve sexual health among individuals with erectile dysfunction?
Which condition is most directly indicated to improve sexual health among individuals with erectile dysfunction?
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The effects of excessive alcohol consumption lead to which sexual health issue in women?
The effects of excessive alcohol consumption lead to which sexual health issue in women?
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Which of the following statements correctly describes the impact of chronic stress on sexual health?
Which of the following statements correctly describes the impact of chronic stress on sexual health?
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What is the common sexual dysfunction experienced by men due to obesity?
What is the common sexual dysfunction experienced by men due to obesity?
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The Female Sexual Function Index (FSFI) is used to measure which aspect of health?
The Female Sexual Function Index (FSFI) is used to measure which aspect of health?
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In which area are women with sedentary lifestyles significantly affected according to the information presented?
In which area are women with sedentary lifestyles significantly affected according to the information presented?
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Study Notes
Female and Male Infertility, Sexual Dysfunction
- Infertility is defined as one year of unprotected intercourse without conception.
- Approximately 85-90% of couples conceive within one year.
- Infertility affects approximately 10-15% of couples.
- Fecundability is the probability of pregnancy in a single cycle, typically 20-25% in healthy couples.
- Fecundity is the probability of a single cycle resulting in pregnancy.
Learning Objectives
- Definition of infertility
- Incidence of infertility
- Causes of infertility
- Research methods for infertility
- Male factors contributing to infertility
- Concepts of sexuality
- Risk factors for sexual dysfunction (SD)
Epidemiology of Infertility in the US
- The crude birth rate decreased from 55 per 1,000 in 1790 to 14.1 per 1,000 in 2001.
- This represents a nearly 75% decline over 200 years.
- Factors contributing to this decline include increased education and career opportunities, later marriage and higher divorce rates, improved contraception, delayed childbearing, and decreased family size.
Normal Reproductive Efficiency
- The percentage of couples who will conceive within a certain time frame.
- Within 3 months, 57% of couples conceive.
- Within 6 months, 72% of couples conceive.
- Within 1 year, 85% of couples conceive.
- Within 2 years, 93% of couples conceive.
Indications for Infertility Evaluation
- Couples who have failed to conceive after one year or more of unprotected intercourse.
- Women over age 35.
- Women with irregular menstrual cycles.
- Women with a family history of early menopause.
- Women with a history of previous ovarian surgery, chemotherapy, or radiation.
- Women who demonstrate a poor response to exogenous gonadotropin stimulation.
Female Infertility Evaluation: History
- Gravity and Parity
- Cycle length and characteristics
- Coital frequency and sexual dysfunction
- Duration of infertility and results of previous evaluations and treatments
- Past surgeries, indications, and outcomes
- Previous abnormal Pap smears
- Current medications and allergies
- Occupation and tobacco, alcohol, and drug use
- Family history of birth defects, early menopause, or reproductive failure
- Symptoms of thyroid disease, pelvic or abdominal pain, galactorrhea, hirsutism, and dyspareunia
Male Factor Infertility: Medical History
- Congenital abnormalities
- Undescended testes
- Prior paternity
- Frequency of intercourse
- Exposure to toxins
- Previous surgeries
- Previous infections and treatment
- Medications and Drugs
- General health (diet, exercise, review of systems)
Physical Examination
- Weight and body mass index (BMI)
- Thyroid enlargement, nodule, or tenderness
- Breast secretions and characteristics
- Signs of androgen excess
- Pelvic or abdominal tenderness
- Vaginal or cervical abnormalities, secretions, or discharge
- Masses, tenderness, or nodularity in the adnexa or cul-de-sac
Screening Tests
- Pap smear
- Blood type, Rh factor, and antibody screening (Rh-negative women)
- Screening for cystic fibrosis
- Screening for TORCH (sexually transmitted diseases)
- Hepatitis B, Chlamydia (RNA/DNA based testing)
- Hepatitis C antibody
- HIV-1 antibody
- Syphilis testing
Causes of Infertility
- Ovulatory dysfunction (15%)
- Tubal or peritoneal pathology (30-40%)
- Male factors (30-40%)
- Unexplained infertility (15-20%)
Causes of Infertility (Proportions)
- Couples: ovulatory dysfunction (15%), unexplained infertility (10%), unusual problems (5%), tubal and pelvic pathology (35%), and male problems (35%)
- Women: ovulatory dysfunction (40%), unexplained infertility (10%), unusual problems (10%), tubal and pelvic pathology (40%),
Causes (Male/Female Factors)
- Various endocrine, anatomic, and other disorders are present in infertility.
- Male Factor: Hypothalamic dysfunction (Kallmann's syndrome), pituitary failure, hyperprolactinemia, exogenous androgens, thyroid disorders, adrenal hyperplasia, congenital absence of vas deferens, obstruction of vas deferens, and congenital abnormalities of the ejaculatory system
- Ovulatory Factor (cont.): Gonadal dysgenesis, premature ovarian failure, ovarian tumor, ovarian resistance, metabolic disease (thyroid disease, liver disease, renal disease), and obesity.
Components of the Human Reproductive Process
- Sperm deposited near cervix around ovulation.
- Sperm must ascend into fallopian tubes to fertilize the oocyte (male factor).
- Ovulation of a mature oocyte must be regular and predictable (ovarian factor).
- Sperm captured, nurtured, and released into the uterus and fallopian tubes (cervical factor).
- Receptive uterus for embryo implantation and subsequent growth (uterine factor).
- Fallopian tubes must transport the sperm and embryos (tubal factor).
Abnormalities of Semen Quality
- Semen volume
- Sperm concentration
- Total sperm per ejaculate
- Sperm total motility
- Sperm progressive motility
- Sperm morphology
Transvaginal Ultrasound with Saline Contrast
- Used to evaluate the uterine cavity, fallopian tubes, and surrounding structures.
Hysteroscopy
- Visual examination of the uterine cavity using a thin, lighted instrument.
Sexual Dysfunction
- Sexual health relates to general health in both genders.
- Sexual health is a complex and multidimensional process controlled by neurological, endocrine, and vascular systems.
- Sexual dysfunction prevents a person from experiencing satisfaction from sexual activity (43% of women, 31% men).
Causes of Sexual Dysfunction
- Physical: Diabetes, cardiac/vascular disorders, neurological problems, hormonal imbalances, kidney/liver failure, alcohol use disorder, substance use disorder, side effects of medications like antidepressants.
- Psychological: Work stress, anxiety, concerns about performance, marital/relationship issues, depression, feelings of guilt, body image concerns, past sexual trauma.
Symptoms of Sexual Dysfunction
- (Men) Erectile dysfunction (inability to achieve or maintain an erection), retarded ejaculation, premature ejaculation.
- (Women) Inability to achieve orgasm, inadequate vaginal lubrication, inability to relax vaginal muscles.
- (Everyone) Lack of interest in/desire for sex, Inability to become aroused, Pain during intercourse
Treatment of Sexual Dysfunction
- Treat the underlying physical or psychological cause.
- Medication (Hormone shots, pills, creams, Viagra, Cialis, Levitra etc.),
- Mechanical aids (vacuum devices, penile implants)
- Sex therapy
- Psychotherapy ( Address past trauma, anxiety, fear, guilt, and poor body image)
- Education and communication
Modifiable Risk Factors
- Smoking
- Physical inactivity
- Obesity
- Excessive alcohol consumption
- Drug consumption
Specific Causes of Erectile Dysfunction (ED)
- Chronic Stress
- Over-the-counter medications.
- Various medications, including antidepressants.
Chronic Stress
- Physiological perspective. Increased chronic stress leads to increased cortisol.
- Extended elevated cortisol can have harmful long-term effects.
Other Factors of Infertility
- Ovarian Reserve (evaluated in women over 35)
- Follicle Stimulating Hormone (FSH)
- Estriol
- Anti-Mullerian Hormone
- Inhibin-B
- Antral Follicle Count (by ultrasound)
Methods for Ovulation Confirmation
- Mid-luteal phase progesterone assay (<3 ng/ml indicates no ovulation)
- Basal body temperature (BBT)
- Cervical mucus changes (crystallization pattern)
- Pelvic ultrasonography
Methods for Uterine Cavity Evaluation
- Hysterosalpingography (HSG)
- Standard transvaginal ultrasound
- Transvaginal ultrasound with saline contrast
- Hysteroscopy
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Description
This quiz explores the definitions, incidence, and causes of infertility, along with male factors impacting conception. It also covers the concepts of sexual dysfunction and the epidemiology of infertility, particularly in the U.S. Test your knowledge on these critical topics in reproductive health.
