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Questions and Answers
What percentage of couples do not conceive in the first year but will conceive in the second year?
What percentage of couples do not conceive in the first year but will conceive in the second year?
What is the cumulative pregnancy rate after two years of regular marital life and unprotected intercourse?
What is the cumulative pregnancy rate after two years of regular marital life and unprotected intercourse?
What type of infertility is experienced by a couple who has previously conceived?
What type of infertility is experienced by a couple who has previously conceived?
What is the result of too frequent intercourse on sperm?
What is the result of too frequent intercourse on sperm?
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What is a common coital difficulty that may contribute to infertility?
What is a common coital difficulty that may contribute to infertility?
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What is a common practice that may interfere with sperm motion?
What is a common practice that may interfere with sperm motion?
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What is the cause of ovulation spotting?
What is the cause of ovulation spotting?
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What is the primary investigation used to assess uterine factor in infertility?
What is the primary investigation used to assess uterine factor in infertility?
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A patient with mild to moderate male factor infertility would be initially treated with?
A patient with mild to moderate male factor infertility would be initially treated with?
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What is the term for the minimal increase of clear watery discharge that occurs during ovulation?
What is the term for the minimal increase of clear watery discharge that occurs during ovulation?
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A patient with unexplained infertility may be treated with?
A patient with unexplained infertility may be treated with?
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What is the primary investigation used to assess tubal factor in infertility?
What is the primary investigation used to assess tubal factor in infertility?
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What is the minimum normal sperm count required for fertility?
What is the minimum normal sperm count required for fertility?
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What is the minimum percentage of progressive motility required for normal sperm motility?
What is the minimum percentage of progressive motility required for normal sperm motility?
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What is the primary investigation for assessing ovulation?
What is the primary investigation for assessing ovulation?
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What is the minimum percentage of live spermatozoa required for normal vitality?
What is the minimum percentage of live spermatozoa required for normal vitality?
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What is the minimum normal value of semen volume required for fertility?
What is the minimum normal value of semen volume required for fertility?
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What is the term for the presence of antibodies against sperm in a woman's cervical mucus?
What is the term for the presence of antibodies against sperm in a woman's cervical mucus?
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What is the term for the presence of multiple small cysts on the ovaries?
What is the term for the presence of multiple small cysts on the ovaries?
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What is the minimum percentage of normal sperm morphology required for normal fertility?
What is the minimum percentage of normal sperm morphology required for normal fertility?
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Study Notes
Infertility
- Infertility is the inability to conceive after one year of regular marital life and unprotected intercourse.
Background
- General incidence of infertile couples is 10-15%.
- Half of those who don't 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 is 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 or infrequent intercourse.
- Coital difficulties (impotence, vaginismus, dyspareunia).
- Vaginal wash after intercourse.
- Use of lubricants interferes with sperm motion.
Male Factor Infertility
- Causes:
- Impaired spermatogenesis.
- Anti-sperm antibodies.
- Obstruction of the 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 problems (polycystic ovary syndrome, luteal phase defect, premature ovarian failure).
- Tubal factors (pelvic adhesions, pelvic infection, endometriosis).
- Uterine factors (congenital anomalies, anatomical abnormalities).
- Cervical factors (antisperm antibodies, chronic cervicitis).
Ovulatory Factor
- Assessment of ovulation:
- History.
- Hormonal profile.
- Ultrasound assessment of ovulation (folliculometry).
- Data in the history that suggest normal ovulation:
- Regular menstrual cycles.
- Mid-cycle ovulatory pain.
- Ovulatory discharge.
- Ovulation spotting.
- Premenstrual symptoms.
Tubal Factor
- Assessment:
- Hystero-salpingography (HSG).
- Laparoscopy.
Uterine Factor
- Assessment:
- Hystero-salpingography (HSG).
- Hysteroscopy.
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.
- Male factor:
- Mild to 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 incidence of infertile couples and the chances of conceiving in a given menstrual cycle.
