INFERTILITY ( MALE & FEMALE)
- Male factor
- coital problems (Frequency, erection,psychological)
- Maternal age
- Ovulatory ( PCOS, POF, Pituitary adenoma)
- Tubal (PID, tubal damage, pelvic adhesions)
- Endometriosis, Uterine adhesions, polyps, myoma
- cervical polyps
- unexplained
HISTORY
- confidentiality & consent ( I may ask you some personal and sensitive questions, is that alright?)
- Any previous pregnancies/ miscarriages
- previous relationships/ about the partner
- how long have you been trying to conceive?
- Relationship between you and your partner?
- any problems during sex - erection/ retrograde ejaculations/ regular sex/ awareness about fertile periods
(Ask these basic questions prior to moving to exclude any pathology)
- 5 P - periods - last LMP, partner, pills/ contraception, Pap test/STI/PID/Pelvic infections
- any weather preferences
- milky discharge from nipples, headache,visual disturbances
- acne, hirsuteness,voice change, weight change
- Change in diet/ exercise
- hot flushes/mood swings (menopausal symptoms)
- past medical history - DM, Thyroid, high blood pressure, chronic illness ( male - mumps, trauma
- gynecological procedure
- family history of sub fertility, POF
MANAGEMENT
REDUCED FREQUENCY OF INTERCOURSE
- Frequency - at least 3 times/ week
- idea about menstrual cycle and fertility period - calculate, plotting temperature, consistency of mucus
- investigations -
Midluteal progesterone
Sperm antibody screening
TVS
Hysteroscopy/ hysterosalphingography
Ovulation tests
- referral to gynecologist/ fertility clinic (where scans and further tests will be decided)
- most of the cases - cause is not known, even everythings failed options are available. (IVF/ICSI/Surrogacy?adoption)
- reduce stress, social worker if needed, counselling with partner, offer partner check up
- Take folic acid, review with investigation, and decision on referral - next visit
