SN7
SHORT NOTE
5M
★ High-yield
Define infertility. Enumerate its causes and outline the investigations.
Definition
Infertility = failure to conceive after one year of regular unprotected intercourse.Primary — never conceived. Secondary — previous conception.
- Affects about 10–15% of couples
- Investigate after 6 months if the woman is over 35
Causes
| Factor | Share | Examples |
|---|---|---|
| Male | 30–40% | Oligospermia, azoospermia, varicocele, cryptorchidism, infection, obstruction |
| Ovulatory | 25–30% | PCOS, hyperprolactinaemia, thyroid disease, premature ovarian failure |
| Tubal and peritoneal | 20–25% | Pelvic inflammatory disease, tuberculosis, endometriosis, adhesions |
| Uterine and cervical | 10% | Fibroids, adhesions (Asherman), hostile cervical mucus |
| Unexplained | 10–15% | — |
- Genital tuberculosis is an important tubal cause in India and often presents as unexplained infertility
Investigations
- Semen analysis first — simplest, cheapest and non-invasive; always investigate the male before subjecting the woman to invasive tests
- Confirm ovulation — day 21 serum progesterone > 5 ng/mL; basal body temperature chart; follicular tracking on ultrasound
- Hormone profile — FSH, LH, prolactin, TSH, AMH (ovarian reserve)
- Tubal patency — hysterosalpingography; laparoscopy with dye test is the gold standard
- Ultrasound — uterine anomalies, fibroids, polycystic ovaries
Management
| Problem | Treatment |
|---|---|
| Anovulation | Clomiphene or letrozole; gonadotrophins; weight loss and metformin in PCOS |
| Tubal block | Tubal surgery or IVF |
| Male factor — mild | Intrauterine insemination |
| Male factor — severe | ICSI |
| Hyperprolactinaemia | Bromocriptine or cabergoline |
| Endometriosis | Laparoscopic ablation; GnRH analogues |
Applied Aspects
- Age is the single most important prognostic factor — female fertility falls sharply after 35 as both the number and quality of oocytes decline
- Lifestyle — stopping smoking, reducing alcohol, correcting weight and timing intercourse to the fertile window are effective and cost nothing
- Infertility is a couple's problem — both partners must be investigated together, and the psychological and social burden, which is considerable in India, must be addressed
All questions in Reproductive System
- Q1Describe the ovarian and uterine changes of the menstrual cycle. Explain its hormonal control. ★
- Q2Define spermatogenesis. Describe its stages, the cells of the testis and the factors controlling it. ★
- Q3Describe the hormones of the placenta and the maternal physiological changes during pregnancy. Add a note on parturition. ★
- Q4Describe the actions and regulation of testosterone. Add a note on puberty in the male. ★
- Q5Describe the physiology of lactation. Explain why milk secretion begins only after delivery. ★
- SN1Describe the mechanism of ovulation and enumerate its indicators. ★
- SN2Classify the methods of contraception. Describe the mechanism of the combined oral contraceptive pill. ★
- SN3Define menopause. Describe the hormonal changes and clinical features. ★
- SN4Describe semen analysis with its normal values. Add a note on the composition of semen. ★
- SN5Describe the changes at puberty in boys and girls and the mechanism of its onset.
- SN6Describe the basis of pregnancy tests. Add a note on the causes of false results.
- SN7Define infertility. Enumerate its causes and outline the investigations. ★