Chapter 10 Infertility
Definitions. Infertility is the failure to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse. Primary infertility is no previous pregnancy, regardless of the outcome. Secondary infertility is previous pregnancy, regardless of the outcome. Fecundability is the probability of achieving a pregnancy per menstrual cycle. Fecundity is the probability of achieving a live birth per menstrual cycle.
Aetiology
The requirements for conception determine the aetiological factors that contribute to infertility:
History
Female
Investigations
Initial investigations
Extended investigations
Management
Principles
Ovulatory factor infertility
Gonadotropin-releasing hormone (GnRH) agonist/antagonists
Pelvic factor infertility
Tubal factors
Assisted reproduction
Definitions. IVF: in-vitro fertilisation; ICSI: intracytoplasmic sperm injection.
Success rates. IVF—fresh embryo transfer: 35–40%; frozen embryo transfer: 25–30%.
Steps in assisted reproduction
Step 1: Controlled ovarian hyperstimulation
Step 2: Egg collection
Step 3: Fertilisation and embryo culture
Ovarian hyperstimulation syndrome
Incidence. Severe OHSS occurs in 0.5% episodes of assisted reproduction.