What defines infertility?
Inability to conceive despite regular unprotected sexual intercourse after 1 year in women under 35 and after 6 months in women 35 and over.
Uterine factors that lead to infertility?
Endometrial polyps
Leiomyoma
Uterine anomalies
Asherman syndrome
First thing to do when assessing infertility?
A detailed medical history!!
What lifestyle modifications can be done?
cessation of alcohol, nicotine, and recreational drugs
Difference between primary and secondary infertility?
- Primary: Infertility in people who have never achieved pregnancy.
- Secondary: Infertility in people who have achieved pregnancy before.
Cervical factors that lead to infertility?
Immune-related (Anti-sperm antibodies in cervical mucus)
Trauma
Diethylstilbestrol exposure in utero
Cervical anomalies (insufficient cervical mucus production).
What does unexplained infertility mean?
Infertility after all testing shows normal results
What can be used to treat underlying causes of infertility?
metformin for PCOS, Levothyroxine for hypothyroidism, Bromocriptine for hyperprolactinemia
How common is infertility in the U.S.?
Infertility is found in 10-15% of couples of reproductive age.
Estimated 5% of women ages 15-44.
Estimated 5-10% of men ages 15-44.
Tubal and pelvic factors that lead to infertility?
Fallopian tube adhesions/obstructions (could follow infection or surgery)
Endometriosis
PID
When is imaging indicated for infertility?
After all lab testing show no abnormalities and no history is indicative of anatomical abnormality/obstruction.
Ovulation induction drugs?
- Clomiphene citrate (Estrogen receptor antagonist)
- Menotropins (Gonadotropins from postmenopausal women)
- Letrozole (aromatase inhibitor)
Risk factors for infertility?
- Endometriosis
- History of PID
- History of pelvic surgery or tract malformations
- Known male factors
Ovarian factors that lead to infertility?
Hyperprolactinoma
Hypothyroidism
PCOS
Primary ovarian insufficiency
What labs can we use to assess ovulation in patients?
- FSH, LH, Estrogen, and progesterone levels
- AMH levels
- Prolactin
- TSH
Most common form of assisted reproductive technology?
In vitro fertilization
What anatomical abnormalities could lead to infertility?
Uterine
Cervical
Tubal
Ovarian
Sperm
Sperm factors that lead to infertility?
Reduced sperm count
Impaired motility
Testicular damage (scrotal injury, testicular torsion)
Immunologic (antisperm antibodies in response to damage to the blood-testis barrier can be caused by trauma or infection)
Medications (anabolic steroids)
What imaging modalities can we use to assess for infertility?
- Ultrasound
- sonohysterography
- chromopertubation
- hysterosalpingography
List 2 non-pharmacologic ways to treat infertility
- In vitro fertilization
- Intracytoplasmic sperm injection
- Intrauterine insemination
- Surgery
- oocyte donation