Obstetrics and Gynecology · MU Sofia

60. Sterility. Infertility

Covers the definition of infertility and its primary and secondary forms, then the causes with approximate shares, presented as a table by cause and example. It walks through the investigation of the man and the woman, including semen analysis thresholds and ovarian reserve and tubal tests, followed by a treatment table matching each problem to options. Assisted reproduction with IVF is outlined, including success rates by age and its main risks.

Inside: 4 sections · 2 tables · 16 flashcards · 2 min

Topic 60 of 61 in the MU Sofia syllabus for Obstetrics and Gynecology (Medicine, Year 5). The free AceMed note covers it in 4 sections, about 216 words (2 min of reading), with 16 flashcards.

In this note

  1. Introduction
  2. Causes
  3. Investigation of the couple
  4. Treatment

Introduction

Infertility is failure to conceive after 12 months of regular unprotected intercourse (6 months if the woman is over 35). It affects about 1 in 6 couples. Primary: never conceived; secondary: after a previous pregnancy. "Sterility" usually means irreversible inability to conceive.

Investigation of the couple

Both

  • History (cycle, pregnancies, STIs, surgery, drugs, lifestyle), examination; folic acid, rubella immunity, cervical screening, BMI, smoking and alcohol.

Man

  • Semen analysis (WHO 2021 lower limits: volume 1.4 ml, concentration 16 million/ml, total motility 42%, normal forms 4%); repeat if abnormal; hormones and urology if abnormal.

Woman

  • Ovulation: cycle history; mid-luteal progesterone (day 21 of 28).
  • Ovarian reserve: AMH and antral follicle count; FSH on days 2–5.
  • Hormones if irregular: LH, FSH, prolactin, TSH, testosterone.
  • Tubal patency: HSG or HyCoSy if no risk factors; laparoscopy with dye test if history of PID, endometriosis or surgery.
  • Uterine cavity: ultrasound, hysteroscopy.

Treatment

Assisted reproduction: IVF

Ovarian stimulation with gonadotrophins and a GnRH antagonist, trigger, egg collection, fertilisation (IVF or ICSI), embryo transfer (usually a single embryo to avoid twins), luteal support. Live birth rate is about 30–40% per cycle under 35 and falls with age. Risks: ovarian hyperstimulation syndrome (OHSS), multiple pregnancy, ectopic pregnancy.

Infertility is a problem of the couple: always do a semen analysis, as male factors are found in about a third of cases.

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