Table of contents
- 1. Infertility
- 2. Approach
- 3. PCOS
Infertility
- Fertility drops >32yo
- Defined as inability to conceive after 1yr, but realistically
- History
- Previous surgery
- Past PID
- Past surgeries (
- Thyroid (Thyroid binding globulin goes up, demand goes up)
Approach
Female Partner
- Egg quality problem / Age / FSH
- Age (decr at 35y and significantly after 40)
- Check FSH at day 3: Normal is <10 mIU/L
- Antral follicle counts (day 3-6)
- Clomifene challenge test (100mg day 3-7 and check FSH on day 10)
- Clomifene increases FSH by >50%
- Ovulation Defect
- Menstrual Hx (cycle length etc... 24-35d normal)
- Sx of ovulation: breast tenderness, moodiness, bloating
- Basal Body Temperature
- Serum Progesterone (to monitor ovulation induction)
- Urine LH kits
- PCOS: 2000-2500mg metformin, stop at 12 weeks because women with PCOS have high risk of first trimester loss
- Anatomical Problem
- Do Hysterosalpingogram (HSG): tubal patency, contour of uterus, and
- sonohysterogram (SHG) U/S + saline
- Hysteroscopy
Male Partner
- Semen Analysis
- Hx or Surgery etc...
- Erectile Dysfunction
- Other: diabetes, HTN, medications (CCB, AntiCh, antideperssants)
Intercourse Timing
- 2-3x/week
- Need to have sex mid-cycle
- Avoid lubricants, spermicides (egg white, canola oil ok
Treatment:
- Counselling
- Meds (clomiphene citrate vs gonadotropins), thyroid
- Intrauterine insemination
- IVF, IVF with intracytoplasmic sperm injection (ICSI), oocyte donation, sperm donation, embryo donation, gestational surrogate
PCOS
- Anovulation (irregular menses), testosterone signs (hair growth, acne, andogeneic alopecia), cystes in ovaries
- PCOS causes abnormal GnRH secretion is changed leading to increase in LH, and low FSH. LH causes theca cells to secrete androgens
...end of document
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