30 Questions
What percentage of infertile couples will conceive in the second year?
Half of them
What is the definition of infertility?
Inability to conceive after one year of regular marital life and unprotected intercourse
What is the general incidence of infertile couples?
10 to 15%
What happens if a couple has too frequent intercourse?
It produces immature sperm
What is the chance of conceiving in any given menstrual cycle?
Less than 20%
What is a type of sexual problem that may contribute to infertility?
All of the above
What is the definition of primary infertility?
A couple who has never conceived
What is the definition of secondary infertility?
A couple who has previously conceived
What can interfere with sperm motion?
Both A and B
What is a consequence of infrequent intercourse?
It carries the possibility of coitus away from the fertile time
What is the name of the pain experienced during ovulation?
Mittelschmerz pain
What is the investigation of choice for assessing the uterine factor in infertility?
Hysteroscopy
What is the treatment for severe male factor infertility?
ICSI
What is the investigation of choice for assessing tubal patency?
Hysterosalpingography (HSG)
What is the term for the adhesions that form in the uterus following a uterine infection or surgery?
Asherman's syndrome
What is the term for the artificial introduction of sperm into the female reproductive tract?
Artificial insemination by husband (AIH)
What is the term for the visualization of the fallopian tubes and uterus using X-ray?
Hysterosalpingography (HSG)
What is the term for the process of fertilization outside the body?
In vitro fertilization (IVF)
What is the investigation of choice for assessing ovulation?
Folliculometry
What is the term for the abnormal connection between the uterus and the fallopian tube?
Hydrosalpinx
What is the minimum percentage of progressive motility required for normal sperm motility?
32%
Which of the following is NOT a cause of female infertility related to the ovulatory factor?
Anti-sperm antibodies
What is the minimum volume of semen required for normal semen analysis?
1.5 ml
What is the primary method used to assess ovulation in females?
Ultrasound assessment of ovulation (folliculometry)
What is the minimum percentage of live spermatozoa required for normal semen analysis?
58%
Which of the following is a cause of male infertility related to impaired spermatogenesis?
Impaired spermatogenesis
What is the minimum percentage of normal sperms required for normal semen analysis?
4%
What is the minimum total sperm count required for normal semen analysis?
39 million per ejaculate
Which of the following is a cause of female infertility related to the uterine factor?
Asherman's syndrome
What is the minimum pH required for normal semen analysis?
7.2
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.
Learn about infertility, its definition, incidence, and types. Understand the chances of conceiving in a given menstrual cycle and the cumulative pregnancy rate.
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