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
