Infertility Overview and Aetiology

Infertility is defined as the inability to conceive after one year of unprotected intercourse. Primary infertility refers to couples who have never conceived, while secondary infertility refers to couples who have previously conceived but are now unable to do so.

The main aetiological groups for female infertility include ovulatory disorders, tubal factors, uterine abnormalities, and age-related factors.

Mrs Ahlam's likely reason for not conceiving is her irregular menstrual cycles, suggestive of anovulation potentially related to her high BMI and polycystic ovary syndrome.

<p>Investigations that could confirm Mrs Ahlam's condition include serum progesterone levels, transvaginal ultrasound to evaluate ovarian morphology, and hormonal assays for LH, FSH, and testosterone.</p> Signup and view all the answers

<p>A normal semen analysis according to WHO values shows a sperm count of at least 15 million sperm per milliliter, 40% or more motility, and 4% or more normal morphology.</p> Signup and view all the answers

<p>Helpful information includes history of pelvic inflammatory disease, surgical history involving the pelvis, and any sexually transmitted infections.</p> Signup and view all the answers

<p>I would induce ovulation using clomiphene citrate, starting on cycle days 3-7.</p> Signup and view all the answers

<p>Potential side effects of ovulation induction include hot flashes, mood swings, ovarian hyperstimulation syndrome, and multiple gestations.</p> Signup and view all the answers

<p>Mrs Ahlam's high BMI could increase the risks of gestational diabetes, hypertension, complications during labour, and may necessitate a cesarean delivery.</p> Signup and view all the answers

<p>Luteinizing Hormone (LH)</p> Signup and view all the answers

<p>BBT rises by half a degree to one degree Fahrenheit after ovulation.</p> Signup and view all the answers

<p>High progesterone confirms that ovulation has occurred and that progesterone production is normal.</p> Signup and view all the answers

<p>The commonly accepted definition of subfertility is the failure to conceive after 12 months of regular unprotected intercourse.</p> Signup and view all the answers

<p>Intercourse should be timed to occur the day of or the day after the LH surge for optimal chances of conception.</p> Signup and view all the answers

<p>Ultrasound monitors follicle growth and the collapse of the fluid-filled cavity after ovulation.</p> Signup and view all the answers

<p>Conception rates increase cumulatively: 70% within 6 months, 80% after 12 months, and 90% after 24 months.</p> Signup and view all the answers

<p>It examines changes in the uterine lining that occur predictably after ovulation.</p> Signup and view all the answers

<p>Increased coital frequency, especially three times a week, significantly enhances the chances of conception compared to once a week.</p> Signup and view all the answers

<p>Eggs are fertilizable for about 12–24 hours post-ovulation, while sperm can survive for up to 72 hours.</p> Signup and view all the answers

<p>It increases by half a degree to one degree Fahrenheit.</p> Signup and view all the answers

<p>LH rises 24 to 48 hours prior to ovulation.</p> Signup and view all the answers

<p>Natural conception rates decline significantly for women after age 35 due to decreasing oocyte quality and quantity.</p> Signup and view all the answers

<p>Factors include smoking, alcohol consumption, stress affecting libido, and body weight issues impacting ovulation.</p> Signup and view all the answers

<p>Primary subfertility refers to couples that have never conceived together, while secondary subfertility involves couples who have previously conceived.</p> Signup and view all the answers

<p>The luteal phase typically lasts about 14 days and is relatively stable, occurring after ovulation.</p> Signup and view all the answers

<p>They have very little impact on fertility.</p> Signup and view all the answers

<p>Endometrial polyps can reduce the chances of implantation, though this effect is not absolute.</p> Signup and view all the answers

<p>Asherman’s syndrome.</p> Signup and view all the answers

<p>Dietary issues and exposure to chemicals.</p> Signup and view all the answers

<p>Diabetes and certain occupations involving chemicals or radiation.</p> Signup and view all the answers

<p>Klinefelter syndrome (XXY).</p> Signup and view all the answers

<p>Anti-Müllerian hormone (AMH).</p> Signup and view all the answers

<p>Chlamydia testing.</p> Signup and view all the answers

<p>The primary purpose of OI in patients with PCOS is to stimulate ovulation when there are ovulatory problems.</p> Signup and view all the answers

<p>Clomiphene citrate functions by binding to estrogen receptors in the hypothalamus and pituitary, blocking feedback loops and stimulating gonadotrophin release.</p> Signup and view all the answers

<p>Approximately 70% of women will ovulate, and about one-half will become pregnant within 6 months.</p> Signup and view all the answers

<p>A major risk associated with clomiphene citrate is the potential for multiple pregnancies, occurring in about 12% of cases.</p> Signup and view all the answers

<p>Alternative treatments for clomiphene-resistant women include augmentation with metformin, aromatase inhibitors, and injectable gonadotrophins.</p> Signup and view all the answers

<p>Hypogonadotrophic hypogonadism results from the pituitary gland's failure to produce gonadotrophins, affecting ovarian stimulation.</p> Signup and view all the answers

<p>One congenital syndrome that can cause this is Kallmann syndrome.</p> Signup and view all the answers

<p>Excessive exercise or psychological stress can lead to slowed or stopped pulsatile secretion of GnRH, resulting in hypothalamic dysfunction.</p> Signup and view all the answers