Approach To A Case Of Infertility.

A 32 year old female presented with the concern of infertility. She got married at the age of 26 but despite trying has not conceived.
1. What relevant points on history should be further explored? enlist 8 points.
2. What are the common causes of infertility in a couple? name any 4
3. List at least 4 investigations that should be advised in this scenario, write in order of importance.

( Question from Family medicine MCPS paper October 19th 2016)

Solution:


1. What relevant points on history should be further explored? enlist 8 points.

Answer:

1. Duration of menstrual cycle (days of flow and days in between the periods )
2. Any pain during the periods. / intercourse. 
3. Whether the menstrual cycle is regular or irregular.
4. Frequency of sexual intercourse
5. H/o any previous marriage (both spouses) and if yes did they conceive previously. 
6. Family history of infertility, miscarriages or stillbirths.  
7. h/o any medical conditions like diabetes, hypo/hyperthyroidism, depression. 
8. Whether the patient is taking any medicines . h/o smoking . 

2. What are the common causes of infertility in a couple? name any 4

Answer: 

1. Male factors like decreased sperm count or decreased motility. 
2. Failure to ovulate. 
3. Endometriosis. 
4. Pelvic inflammatory disease causing damage to the Fallopian tubes. 

3. List at least 4 investigations that should be advised in this scenario, write in order of importance. 

Answer: 

1. Semen analysis ( easy, and able to rule out male factors) 
2. Pelvic ultrasound (will rule out any abnormalities like ovarian cysts, uterine fibroid)
3. Thyroid profile
4. Hysterosalpingograpy ( to determine the patency of Fallopian tubes) 
5. Cycle day 21 progesterone ( to determine ovulation) 
6. Serum prolactin
7. Cycle day 3 FSH ( to check for ovarian function)