Infertility resident survival guide

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. 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.

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• Life threatening cause 2
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Common Causes

• Common cause 1
• Common cause 2
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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

❑ Hysterosalpingography ❑ Laproscopy

Anovulatory cycle

Ovulatory cycle

Progressive motile sperm seen

Sperm antibodies

Investigate the following ❑ Serum FSH ❑ Serum LH ❑ Serum Prolactin ❑ TSH level ❑ If hirsutism is present check testosterone levels and 17-Hydroxyprogesterone levels ❑ If FSH and LH levels are in the low-normal range, but with high prolactin, consider CT or MRI of the head

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

Non secretory endometrium

Secretory endometrium

Luteal phase defect

Confirmed by basal body temperature or repeat endometrial biopsy and serum progesterone estimated on 8th day

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

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References

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