ACOG Infertility (Questions & Answers) Rated 100% Correct!!

Define infertility and subsequent infertility evaluation (timing) - Women older than 35 years should receive an expedited evaluation and undergo treatment after 6 months of failed attempts to become pregnant or earlier, if clinically indicated. In women older than 40 years, more immediate evaluation and treatment are warranted. If a woman has a condition known to cause infertility, the obstetrician-gynecologist should offer immediate evaluation. For infertility assessment: a targeted physical examination of the female partner should be performed with a focus on vital signs and include: - a thyroid, breast, and pelvic examination. For the female partner, tests will focus on - ovarian reserve, ovulatory function, and structural abnormalities Infertility affects what percent of couples: - 15% Indications for immediate infertility evaluation include the following: - - oligomenorrhea or amenorrhea - known or suspected uterine, tubal, or peritoneal disease - stage III or stage IV endometriosis - known or suspected male infertility Basic infertility evaluation components - Female: History, Physical, Prepregnancy evaluation Additional evaluation for etiology of infertility: - diminished ovarian reserve (AMHor basal FSH and estradiol or Transvaginal US with astral follicle count) - Ovulatory dysfunction (ovulatory function test (serum progesterone measurement) - Tubal factor (HSG, Hysterosalpingo-constrast sonography) - Uterine factor ( Transvaginal US, sonohysterography, hysteroscopy, HSG) Male: history and semen analysis Key historical factors to elicit from the patient undergoing infertility evaluation include the following - -duration of infertility and results of any previous evaluation and treatment -menstrual history (including age at menarche, cycle interval, length, and characteristics; presence of molimina [mild premenstrual symptoms and changes]; and onset and severity of dysmenorrhea), signs of ovulation including positive ovulation tests, cervical mucus changes, or biphasic basal body temperatures -pregnancy history (gravidity, parity, time to preg- nancy, fertility treatments, pregnancy outcome, delivery route, and associated complications) -previous methods of contraception - coital frequency and timing - sexual dysfunction - past surgery (procedures, indications, and out- comes) focused on abdominal and pelvic procedures - previous hospitalizations, serious illnesses, or injuries- gynecologic history (eg, pelvic inflammatory disease, sexually transmitted infections, endometriosis, leiomyomas) - sexual history - review of organ systems, including history of thyroid disease, galactorrhea, hirsutism, pelvic or abdominal pain, and dyspareunia - previous abnormal cervical cancer screening tests and any subsequent treatment - current medications and supplements, with an emphasis on identifying allergies and potential teratogens - family history of birth defects, developmental delay, early menopause, or reproductive problems - occupation and exposure to known environmental hazards and -use of nicotine products, alcohol, and recreational or illicit drugs Physical exam of female infertility patient: - - weight, body mass index, blood pressure, and pulse -thyroid enlargement and presence of any nodules or tenderness - breast secretions and their character - signs of androgen excess - tanner staging of breasts and pubic and axillary hair - vaginal or cervical abnormality, secretions, or discharge- pelvic or abdominal tenderness, organ enlargement, or masses - uterine size, shape, position, and mobility - adnexal masses or tenderness andc cul-de-sac masses, tenderness, or nodularity