Infertility resident survival guide: Difference between revisions
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{{familytree | | | | | | | | C01 | | | C01= '''Initial investigations'''}} | {{familytree | | | | | | | | C01 | | | C01= '''Initial investigations'''}} | ||
{{familytree | | | | | | | | |!| | | |}} | {{familytree | | | | | | | | |!| | | |}} | ||
{{familytree | | | | | | | | D01 | | | | | | | |D01=<div style="float: left; text-align: left; line-height: 150% ">❑ [[Urine]] examination <br>❑ [[Complete blood count]] <br>❑ [[Semen]] analysis </div>}} | {{familytree | | | | | | | | D01 | | | | | | | |D01=<div style="float: left; text-align: left; line-height: 150% ">❑ [[Urine]] examination <br>❑ [[Complete blood count]] <br>❑ Fasting and post prandial blood sugar estimation <br>❑ [[Semen]] analysis </div>}} | ||
{{familytree | | | | | | | | |!| | | | | | | | | |}} | {{familytree | | | | | | | | |!| | | | | | | | | |}} | ||
{{familytree | | | | | | | | E01 |E01=Normal semen analysis}} | {{familytree | | | | | | | | E01 |E01=Normal semen analysis}} | ||
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{{familytree | F01 | | | | | F02 | | | F03 | | | F04 |F01=[[Ovary|Ovarian causes]]|F02=[[Endometrium|Endometrial causes]]|F03=[[Cervix|Cervical causes]]|F04=[[Fallopian tube]] causes}} | {{familytree | F01 | | | | | F02 | | | F03 | | | F04 |F01=[[Ovary|Ovarian causes]]|F02=[[Endometrium|Endometrial causes]]|F03=[[Cervix|Cervical causes]]|F04=[[Fallopian tube]] causes}} | ||
{{familytree | |!| | | | | | |!| | | | |!| | | | |!|}} | {{familytree | |!| | | | | | |!| | | | |!| | | | |!|}} | ||
{{familytree | G01 | | | | | G02 | | | G03 | | | G04 |G01=<div style="float: left; text-align: left; line-height: 150% ">'''Methods to detect ovulation''' <br>❑ Basal body temperature measurement throughout cycle <br>❑ Vaginal cytology <br>❑ Cervical mucus study <br>❑ Serum [[progesterone]] <br>❑ Serum [[Lutenizing hormone]] <br>❑ Serum [[estradiol]] <br>❑ Urine [[Lutenizing hormone]] level <br>❑ [[Transvaginal ultrasound]]|G02=Endometrial [[biopsy]]|G03= Cervical mucus study|G04=<div style="float: left; text-align: left; line-height: 150% ">❑ [[Hysterosalpingography]] <br>❑ [[Laproscopy]]</div>}} | {{familytree | G01 | | | | | G02 | | | G03 | | | G04 |G01=<div style="float: left; text-align: left; line-height: 150% ">'''Methods to detect ovulation''' <br>❑ Basal body temperature measurement throughout cycle <br>❑ Vaginal cytology <br>❑ Cervical mucus study <br>❑ Serum [[progesterone]] <br>❑ Serum [[Lutenizing hormone]] <br>❑ Serum [[estradiol]] <br>❑ Urine [[Lutenizing hormone]] level <br>❑ [[Transvaginal ultrasound]]|G02=Endometrial [[biopsy]] on day 21-23|G03= Cervical mucus study/ Sperm cervical mucus contact test|G04=<div style="float: left; text-align: left; line-height: 150% ">❑ [[Hysterosalpingography]] <br>❑ [[Laproscopy]]</div>}} | ||
{{familytree | |!| | | | | | |!| | | | |!| | | | |}} | |||
{{familytree |,|^|-|-|.| | | |!| |,|-|-|^|-|-|.|}} | |||
{{familytree | H01 | | H02 | |!| | H03 | | | H04|H01=Anovulatory cycle|H02=Ovulatory cycle|H03=Progressive motile sperm seen|H04=Sperm antibodies}} | |||
{{familytree | |!| | | |!| | |!| | | | | | | |!|}} | |||
{{familytree | I01 | | I02 | |!| | | | | | | I03|I01=<div style="float: left; text-align: left; line-height: 150% ">'''Investigate the following''' <br>❑ Serum [[Follicle stimulating hormone|FSH]] <br>❑ Serum [[Lutenizing hormone|LH]] <br>❑ Serum [[Prolactin]] <br>❑ [[Thyroid stimulating hormone|TSH]] level <br>❑ If [[hirsutism]] is present check [[testosterone]] levels and [[17-Hydroxyprogesterone]] levels <br>❑ If [[Follicle stimulating hormone|FSH]] and [[Lutenizing hormone|LH]] levels are in the low-normal range, but with high [[prolactin]], consider [[CT]] or [[MRI]] of the [[head]]|I02=If age is >30 years, work up with all other investigations including day 3 [[Follicle stimulating hormone|FSH]]|I03= Occasionally, IgG, IgA or IgM antibodies are found against sperm. Treating these anti-sperm antibodies have not shown an improved outcome in pregnancies. Treatment is along the lines of [[IVF]] </div>}} | |||
{{familytree/end}} | {{familytree/end}} | ||
Revision as of 04:28, 3 September 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sanjana Nethagani, M.B.B.S.[2]
Synonyms and keywords:
Overview
Infertility is defined as a failure to conceive after one or more years of unprotected intercourse[1]. Infertility is divided broadly into primary and secondary infertility where primary infertility is failure to conceive and secondary infertility is failure to conceive after a previous pregnancy. Multiple factors play a role in conception and infertility such as healthy spermatozoa, regular ovulation, patent fallopian tubes, normal uterine cavity etc.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
Common Causes
Diagnosis
Shown below is an algorithm summarizing the diagnosis of male infertility
| Couple with infertility | |||||||||||||||||||||||||||||||||||||||
Detailed history including ❑ Any history of abdominal or pelvic surgery? ❑ Menstrual history ❑ History of contraceptive use ❑ Obstetric history | |||||||||||||||||||||||||||||||||||||||
| Initial investigations | |||||||||||||||||||||||||||||||||||||||
❑ Urine examination ❑ Complete blood count ❑ Fasting and post prandial blood sugar estimation ❑ Semen analysis | |||||||||||||||||||||||||||||||||||||||
| Normal semen analysis | |||||||||||||||||||||||||||||||||||||||
| Ovarian causes | Endometrial causes | Cervical causes | Fallopian tube causes | ||||||||||||||||||||||||||||||||||||
Methods to detect ovulation ❑ Basal body temperature measurement throughout cycle ❑ Vaginal cytology ❑ Cervical mucus study ❑ Serum progesterone ❑ Serum Lutenizing hormone ❑ Serum estradiol ❑ Urine Lutenizing hormone level ❑ Transvaginal ultrasound | Endometrial biopsy on day 21-23 | Cervical mucus study/ Sperm cervical mucus contact test | |||||||||||||||||||||||||||||||||||||
| Anovulatory cycle | Ovulatory cycle | Progressive motile sperm seen | Sperm antibodies | ||||||||||||||||||||||||||||||||||||
| If age is >30 years, work up with all other investigations including day 3 FSH | Occasionally, IgG, IgA or IgM antibodies are found against sperm. Treating these anti-sperm antibodies have not shown an improved outcome in pregnancies. Treatment is along the lines of IVF | ||||||||||||||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Do's
- The content in this section is in bullet points.
Don'ts
- The content in this section is in bullet points.
References
- ↑ Gnoth C, Godehardt E, Frank-Herrmann P, Friol K, Tigges J, Freundl G (2005). "Definition and prevalence of subfertility and infertility". Hum Reprod. 20 (5): 1144–7. doi:10.1093/humrep/deh870. PMID 15802321.