WH: Infertility

Treatment of male infertility

Avoid alcohol intake, tight underwear, hot tubs, environmental exposures intracytoplasmic sperm injection (IVF)

What are the most common causes of male infertility?

Endocrine (hypothalmic, anabolic steroids, thyroid disease, hyperprolactinemia) Anatomic defects Sexual dysfunction (ex. impotence) Abnormal sperm production or motility

_____the likelihood of conception/month of exposure; 20-25% in normal fertile couples having frequent intercourse; 85-90% couples with unprotected intercourse will conceived within 1 year

Fecundability

______ the probability of achieving a live birth in 1 menstrual cycle

Fecundity

_________ is defined as inability of a couple to conceive after 12 months of unprotected, frequent intercourse without use of contraception in women <35 yo and in 6 months in women >35 yo

Female infertility

What are the most common causes of female infertility?

Ovulatory (25%) Endometriosis Pelvic adhesions Tubal blockage Other tubal abnormalities Hyperprolactinemia

Second degree infertility...

couples who have achieved pregnancy previously, but are currently having difficulty conceiving after 1 year

What is a major side effect of clomiphene citrate?

multiple-gestation pregnancy

First degree infertility...

neither partner has acheived a successful pregnancy

What is the first test to order for a couple with infertility?

semen analysis may require laparoscopic evaluation, assess patency of fallopian tubes with hysterosalpingogram Pelvic US Karyotype

What is some clinical testing required to evaluate male infertility?

semen analysis (always first!) - repeat if abnormal

What is the treatment plan after diagnosis of female infertility?

stop smoking, limit alcohol, reduce caffeine, manage stress, exercise, maintain normal weight Time intercourse with ovulation - intercourse starting 6 days prior to ovulation on every other day Clomiphene citrate - to induce ovulation by stimulating release of GnRH, which stimulates FSH and LH release and follicular development (50 mg/day on day 3 to 7 of menstrual cycle), ovulation is expected 5-10 days after treatment

What is the most common cause of male infertility?

varicocele