Infertility in Obstetrics and Gynecology

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Questions and Answers

What is the percentage of infertile couples in the general population?

20 to 25%

10 to 15% (correct)

5 to 10%

30 to 35%

What is the cumulative pregnancy rate for couples who do not conceive in the first year?

Over 95%

Over 50%

Over 80%

Over 90% (correct)

What is the effect of too frequent intercourse on sperm?

It increases sperm count

It has no effect on sperm

It increases sperm motility

It produces immature sperm (correct)

What is the definition of primary infertility?

A couple who has never conceived Signup and view all the answers

What is the effect of using lubricants during intercourse on sperm?

It interferes with sperm motion Signup and view all the answers

What is the time period after which a couple is considered infertile?

1 year Signup and view all the answers

What is the minimum volume of semen required for normal semen parameters?

1.5 ml Signup and view all the answers

What is the percentage of normal sperms required for normal semen parameters?

4% Signup and view all the answers

Which of the following is a cause of female infertility?

Pelvic endometriosis Signup and view all the answers

What is the minimum total sperm count required for normal semen parameters?

39 million per ejaculate Signup and view all the answers

Which of the following is a method of assessing ovulation?

Hormonal profile Signup and view all the answers

What is the minimum pH required for normal semen parameters?

7.2 Signup and view all the answers

Which of the following is a cause of male infertility?

Obstruction of seminal tract Signup and view all the answers

What is the percentage of total motility required for normal semen parameters?

40% Signup and view all the answers

What is the cause of ovulation spotting?

Transient drop in estrogen level with rupture of the follicle Signup and view all the answers

Which investigation is used to diagnose intrauterine adhesions?

Hysteroscopy Signup and view all the answers

What is the treatment for severe male factor infertility?

Intracytoplasmic sperm injection (ICSI) Signup and view all the answers

What is the investigation of choice for diagnosing tubal factor infertility?

Hystero-salpingography (HSG) Signup and view all the answers

What is the treatment for unexplained infertility?

Induction of ovulation with artificial insemination by husband (AIH) Signup and view all the answers

What is the term for few drops of blood due to transient drop in estrogen level with rupture of the follicle?

Ovulation spotting Signup and view all the answers

Study Notes

Infertility

Infertility is the inability to conceive after one year of regular, unprotected marital life and intercourse.

Background

The general incidence of infertile couples is 10-15%.
Half of those who do not conceive in the first year will do so in the second year, with a cumulative pregnancy rate over 90%.
The chances of conceiving in any given menstrual cycle are less than 20%.

Types of Infertility

Primary infertility: a couple who has never conceived.
Secondary infertility: a couple who has previously conceived, regardless of the pregnancy outcome.

Causes of Infertility

Sexual Problems

Too frequent intercourse produces immature sperm.
Infrequent intercourse may lead to coitus away from the fertile time.
Coital difficulties: impotence, vaginismus, dyspareunia.
Vaginal wash after intercourse may interfere with sperm motion.
Use of lubricants may interfere with sperm motion.

Male Factor Infertility

Causes:
- Impaired spermatogenesis
- Anti-sperm antibodies
- Obstruction of seminal tract
- Defective delivery of sperm
Investigations:
- Semen analysis
- Normal semen parameters:
  - Volume: ≥ 1.5 ml
  - pH: ≥ 7.2
  - Sperm count: ≥ 15 million per ml
  - Total sperm count: ≥ 39 million per ejaculate
  - Motility: ≥ 40% total motility, ≥ 32% progressive motility
  - Vitality: ≥ 58% live spermatozoa
  - Morphology: ≥ 4% normal sperms

Female Factor Infertility

Causes:
- Ovulatory disorders:
  - Polycystic ovary syndrome (PCOS)
  - Luteal phase defect
- Tubal factors:
  - Pelvic adhesions
  - Pelvic infection
  - Endometriosis
- Uterine factors:
  - Congenital anomalies
  - Anatomical abnormalities
  - Chronic cervicitis
Investigations:
- History
- Hormonal profile
- Ultrasound assessment of ovulation (folliculometry)

Assessment of Ovulation

Data in the history that suggest normal ovulation:
- Regular menstrual cycles
- Mid-cycle ovulatory pain (Mittelschmerz pain)
- Ovulatory discharge: minimal increase of clear watery discharge
- Ovulation spotting: few drops of blood due to transient drop in estrogen level with rupture of the follicle
- Premenstrual symptoms: e.g. mastalgia, spastic dysmenorrhea

Tubal Factor Infertility

Assessment:
- Hystero-salpingography (HSG)
- Laparoscopy
Findings:
- Hydro-salpinx
- Tubal block

Uterine Factor Infertility

Assessment:
- Hystero-salpingography (HSG)
- Hysteroscopy
Findings:
- Intrauterine adhesions (= Asherman's syndrome)
- Intrauterine septum

Basic Workup for Infertility

Detailed history and physical examination
Evidence of ovulation
Semen analysis
Hormonal profile:
- Serum FSH
- Serum LH
- Serum prolactin
- Thyroid function tests
Trans-vaginal ultrasound and folliculometry
Hystero-salpingography (HSG)

Further Investigations

Laparoscopy
Hysteroscopy

Treatment

Sexual problems: advise and correct, AIH
Male factor infertility:
- Mild, moderate: medical treatment then AIH
- Severe: ICSI
Ovulatory factor:
- Induction of ovulation
- IVF/ICSI
Tubal factor:
- IVF/ICSI
Unexplained infertility:
- Induction of ovulation ± AIH
- IVF/ICSI

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Description

This quiz covers the definition, background, and types of infertility, including the general incidence of infertile couples and the chances of conceiving in any given menstrual cycle.