44 INFERTILITY, FEMALE General Discussion Infertility affects one couple in six and becomes more common with increasing age. Clinical evaluation of infertility is indicated if a pregnancy has not occurred after 1 year of regular unprotected intercourse. An infertility work-up should also be initiated on female patients who complain of infertility and have any of the following abnormalities: irregular menses or amenorrhea, bleeding between periods, dyspareunia, history of upper genital tract infection, history of a ruptured appendix or other abdominal surgery, or age greater than 35 years. Because men account for some 40% of all infertility, the male partner should be evaluated early in the infertility work-up. Historical factors affecting the male partner should also be considered in determining when to begin an infertility evaluation. The following historical factors in the male partner warrant an early investigation: difficulty achieving or maintaining an erection, inability to ejaculate during intercourse, history of testicular injury, history of mumps, history of an undescended testicle, or history of infection in the prostate gland, epididymis, or testicles. There are several tests that every infertile couple should have performed. The first is a semen analysis of the male partner regardless of how many pregnancies he has caused because sperm counts can change over time. The second test is a hysterosalpingogram (HSG), which helps determine whether the uterine cavity is normal in size and shape and whether the fallopian tubes are patent. Though the HSG is the initial test to evaluate tubal patency, patients at high risk for infection, such as those with a history of clinically diagnosed pelvic inflammatory disease (PID), are best evaluated initially via laparoscopy and hysteroscopy. Laparoscopy is more invasive than HSG, but remains the best test to identify endometriosis and peritubal adhesions. Routine hormonal assessment, especially in a young apparently ovulatory patient, is controversial. There is less disagreement about performing a hormonal assessment in women aged 35 years and older. The suggested work-up is outlined below. Approximately 5–10% of infertile couples proceed through a complete infertility evaluation without a cause identified and are said to have unexplained infertility. Additional specialized testing may be performed by infertility clinics, such as ultrasound, antisperm antibodies, and sperm function assays. Empiric treatment regimens have been designed to treat subtle disorders that may not be diagnosed. Causes of Female Infertility Endometriosis Male factors Ovulatory dysfunction • Amenorrhea • Hyperprolactinemia • Oligomenorrhea Tubal disease Uterine causes • Intrauterine synechiae (Asherman’s syndrome) • Septate uterus • Uterine fibroids Unexplained infertility Key Historical Features ✓ Patient age Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS INFERTILITY, MALE SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on INFERTILITY, FEMALE Full access? Get Clinical Tree
44 INFERTILITY, FEMALE General Discussion Infertility affects one couple in six and becomes more common with increasing age. Clinical evaluation of infertility is indicated if a pregnancy has not occurred after 1 year of regular unprotected intercourse. An infertility work-up should also be initiated on female patients who complain of infertility and have any of the following abnormalities: irregular menses or amenorrhea, bleeding between periods, dyspareunia, history of upper genital tract infection, history of a ruptured appendix or other abdominal surgery, or age greater than 35 years. Because men account for some 40% of all infertility, the male partner should be evaluated early in the infertility work-up. Historical factors affecting the male partner should also be considered in determining when to begin an infertility evaluation. The following historical factors in the male partner warrant an early investigation: difficulty achieving or maintaining an erection, inability to ejaculate during intercourse, history of testicular injury, history of mumps, history of an undescended testicle, or history of infection in the prostate gland, epididymis, or testicles. There are several tests that every infertile couple should have performed. The first is a semen analysis of the male partner regardless of how many pregnancies he has caused because sperm counts can change over time. The second test is a hysterosalpingogram (HSG), which helps determine whether the uterine cavity is normal in size and shape and whether the fallopian tubes are patent. Though the HSG is the initial test to evaluate tubal patency, patients at high risk for infection, such as those with a history of clinically diagnosed pelvic inflammatory disease (PID), are best evaluated initially via laparoscopy and hysteroscopy. Laparoscopy is more invasive than HSG, but remains the best test to identify endometriosis and peritubal adhesions. Routine hormonal assessment, especially in a young apparently ovulatory patient, is controversial. There is less disagreement about performing a hormonal assessment in women aged 35 years and older. The suggested work-up is outlined below. Approximately 5–10% of infertile couples proceed through a complete infertility evaluation without a cause identified and are said to have unexplained infertility. Additional specialized testing may be performed by infertility clinics, such as ultrasound, antisperm antibodies, and sperm function assays. Empiric treatment regimens have been designed to treat subtle disorders that may not be diagnosed. Causes of Female Infertility Endometriosis Male factors Ovulatory dysfunction • Amenorrhea • Hyperprolactinemia • Oligomenorrhea Tubal disease Uterine causes • Intrauterine synechiae (Asherman’s syndrome) • Septate uterus • Uterine fibroids Unexplained infertility Key Historical Features ✓ Patient age Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS INFERTILITY, MALE SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on INFERTILITY, FEMALE Full access? Get Clinical Tree
