Infertility

Rationale

Infertility is a common condition that is defined as the inability of a couple to conceive after one year of sexual intercourse without contraception. Both partners must be investigated.

Causal Conditions

(list not exhaustive)

1. Female
   1. Ovulatory dysfunction (e.g., hypogonadotropic hypogonadism, polycystic ovary syndrome)
   2. Tubal and peritoneal abnormalities (e.g., pelvic inflammatory disease)
   3. Uterine and cervical factors (e.g., fibroids)
   4. Immune and genetic causes
2. Male
   1. Testicular dysfunction (e.g., viral orchitis)
   2. Endocrine causes (e.g., hypogonadotropic hypogonadism)
   3. Posttesticular dysfunction (e.g. abnormal sperm transport)

Key Objectives

Given a couple with infertility, the candidate will diagnose the cause and will explain the therapeutic options.

Enabling Objectives

Given a couple with infertility, the candidate will

1. list and interpret critical clinical findings, including those derived from an appropriate history and physical examination of both partners;
2. list and interpret critical investigations, including
   1. semen analysis,
   2. tests confirming ovulation, and
   3. other laboratory tests (e.g., prolactin level, thyrotropin [thyroid-stimulating hormone] level);
3. construct an effective initial management plan, including
   1. counselling the couple regarding preconceptual use of folic acid,
   2. counselling and educating the couple regarding diagnostic and therapeutic options,
   3. determining whether either patient requires specialized care,
   4. recommending lifestyle changes if indicated, and
   5. providing counselling regarding psychosocial stresses if indicated.