1. Infertility Chris Jordan

2. Contents Definition Examination Tests Lifestyle Causes Female Causes Male Causes Treatments

3. Infertility Infertility is the failure to conceive (regardless of cause) after 1 year of unprotected intercourse Affects approximately 10-15% of reproductive- aged couples Male and female factors each account for approximately 35% of cases Mixed male and female causes 20% of infertility 10% of cases, the etiology is unknown

4. Examination Female – BMI – Signs of thyroid disease – Signs of chromosomal abnormality (eg Turners) – Breast exam: rule out masses or secretions, especially galactorrhea – Speculum examination: Swabs for STIs; assess for cervical stenosis – Bimanual examination: Establish direction of the cervix plus size/position of the uterus – Acne and hirsutism Male – Congenital abnormalities of the genital tract (eg, hypospadias) – Testicular size, urethral stenosis, and presence of any varicocele – Any previous inguinal hernia repair: Can indicate accidental ligation of spermatic artery

5. Tests Progesterone levels and/or serial ultrasonography to assess ovulation; follicle- stimulating hormone and oestrogen levels Semen analysis Hysterosalpingogram Laparoscopy

6. Lifestyle Causes Smoking Recreational Drugs Excessive exercise Extreme weight loss or gain Advancing Age Alcohol excess

7. Female Cervical (5-10% of infertility) – Stenosis – Thickened mucous Medication Hormonal imbalance Uterine (2-5% of infertility) – Congenital (drug induced / genetic) Septate /Bicornate / unicornate uterus – Aquired Intrauterine adhesions Fibroids

8. Female Ovarian – Failure to ovulate Primary – eg Turners Secondary – Premature ovarian failure – Pituitary tumours – Thyroid disease Oligomenorrhea – Obesity – PCOS Age - 11% at 34 / 33% at 40 / 87% at 45 PID Endometriosis

10. Male Pretesticular – Pituitary tumours Testicular – Genetic XXY – Non-genetic Infections Varicocele Drugs Posttesticular – Surgery – Genetic eg CF

11. Treatment Treat the cause if possible Refer to fertility clinic after 1 year Treatment examples – Cervical cause: Interuterine insemination – Ovarian cause: Clomid Side effects – ovarian hyperstimulation, ascites – IVF

12. IVF Funding Up to 3 cycles if… – 23-39 – Identifiable cause – Over 3 years of trying to concieve – Normal BMI – No children