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Questions and Answers
Mittelschmerz pain is a symptom of premenstrual syndrome
Mittelschmerz pain is a symptom of premenstrual syndrome
False (B)
Hysteroscopy can diagnose intrauterine adhesions
Hysteroscopy can diagnose intrauterine adhesions
True (A)
Serum FSH levels are not relevant to infertility investigations
Serum FSH levels are not relevant to infertility investigations
False (B)
Laparoscopy is used to diagnose hydro-salpinx
Laparoscopy is used to diagnose hydro-salpinx
ICSI is a treatment option for unexplained infertility
ICSI is a treatment option for unexplained infertility
Hystero-salpingography is used to diagnose tubal blockage
Hystero-salpingography is used to diagnose tubal blockage
Artificial insemination by husband is a treatment option for male factor infertility
Artificial insemination by husband is a treatment option for male factor infertility
Ovulation spotting is a symptom of premenstrual syndrome
Ovulation spotting is a symptom of premenstrual syndrome
A semen analysis parameter is a volume of ≥ 1 ml.
A semen analysis parameter is a volume of ≥ 1 ml.
Hysteroscopy can diagnose intrauterine septum
Hysteroscopy can diagnose intrauterine septum
Induction of ovulation is a treatment option for unexplained infertility
Induction of ovulation is a treatment option for unexplained infertility
Uterine anomalies are a cause of male infertility.
Uterine anomalies are a cause of male infertility.
A hormonal profile is used to assess ovulation.
A hormonal profile is used to assess ovulation.
A semen analysis parameter is a total sperm count of ≥ 10 million per ejaculate.
A semen analysis parameter is a total sperm count of ≥ 10 million per ejaculate.
Pelvic infection is a cause of male infertility.
Pelvic infection is a cause of male infertility.
Anti-sperm antibodies are a cause of female infertility.
Anti-sperm antibodies are a cause of female infertility.
A semen analysis parameter is a motility of ≥ 20% total motility.
A semen analysis parameter is a motility of ≥ 20% total motility.
Ultrasound assessment of ovulation is used to assess ovulation.
Ultrasound assessment of ovulation is used to assess ovulation.
Regular menstrual cycles are a sign of abnormal ovulation.
Regular menstrual cycles are a sign of abnormal ovulation.
Asherman’s syndrome is a cause of male infertility.
Asherman’s syndrome is a cause of male infertility.
A couple who has previously conceived is considered to have primary infertility.
A couple who has previously conceived is considered to have primary infertility.
The general incidence of infertile couples is around 5-10%.
The general incidence of infertile couples is around 5-10%.
The chances of conceiving in any given menstrual cycle is more than 50%.
The chances of conceiving in any given menstrual cycle is more than 50%.
Impotence is a coital difficulty that may contribute to infertility.
Impotence is a coital difficulty that may contribute to infertility.
Vaginal wash before intercourse can interfere with sperm motion.
Vaginal wash before intercourse can interfere with sperm motion.
Infertility is defined as the inability to conceive after six months of regular marital life and unprotected intercourse.
Infertility is defined as the inability to conceive after six months of regular marital life and unprotected intercourse.
Dyspareunia is a type of infertile couple.
Dyspareunia is a type of infertile couple.
Half of the couples who do not conceive in the first year will conceive in the third year.
Half of the couples who do not conceive in the first year will conceive in the third year.
Too frequent intercourse produces immature eggs.
Too frequent intercourse produces immature eggs.
Lubricants can enhance sperm motion.
Lubricants can enhance sperm motion.
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Study Notes
Infertility
- Inability to conceive after one year of regular, unprotected marital life and intercourse.
Background
- 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 (cumulative pregnancy rate over 90%).
- Chances of conceiving in any given menstrual cycle are less than 20%.
Types of Infertility
- Primary: a couple who has never conceived.
- Secondary: a couple who has previously conceived, regardless of the pregnancy outcome.
Causes of Infertility
Sexual Problems
- Too frequent intercourse produces immature sperms.
- Infrequent intercourse carries the possibility of coitus away from the fertile time.
- Coital difficulties: impotence, vaginismus, dyspareunia.
- Vaginal wash after intercourse.
- Use of lubricants interferes with sperm motion.
Male Factor Infertility
- Impaired spermatogenesis.
- Anti-sperm antibodies.
- Obstruction of seminal tract.
- Defective delivery of sperm.
Female Factor Infertility
- Ovulatory:
- Polycystic ovary syndrome (PCOS).
- Luteal phase defect.
- Premature ovarian failure.
- Resistant ovary syndrome.
- Uterine:
- Congenital anomalies.
- Anatomical abnormalities.
- Cervical:
- Chronic cervicitis.
- Antisperm antibodies.
Investigations
- Semen analysis:
- Normal parameters: volume ≥ 1.5 ml, pH ≥ 7.2, sperm count ≥ 15 million/ml, etc.
- Assessment of ovulation:
- History.
- Hormonal profile.
- Ultrasound assessment of ovulation (folliculometry).
- Tubal factor assessment:
- Hystero-salpingography (HSG).
- Laparoscopic assessment.
- 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).
Treatment
- Sexual problems: advise and correct.
- Artificial insemination by husband (AIH).
- Male factor:
- Mild to moderate: medical treatment then AIH.
- Severe: intracytoplasmic sperm injection (ICSI).
- Ovulatory factor:
- Induction of ovulation.
- IVF / ICSI.
- Tubal factor:
- IVF / ICSI.
- Unexplained infertility:
- Induction of ovulation ± AIH.
- IVF / ICSI.
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