Infertility

Rationale

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

Causal Conditions

(list not exhaustive)

1. Female
   1. Ovulatory dysfunction (e.g., hypogonadotropic hypogonadism, polycystic ovarian syndrome)
   2. Tubal and peritoneal abnormalities (e.g., pelvic inflammatory disease [PID])
   3. Uterine and cervical factors (e.g., fibroids)
2. Male
   1. Testicular dysfunction (e.g., hypogonadotropic hypogonadism, viral orchitis)
   2. Post-testicular dysfunction (e.g., abnormal sperm transport)

Key Objectives

Given a couple with infertility, the candidate will diagnose the cause and complications, 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;
   3. other laboratory tests (e.g., prolactin, thyroid-stimulating hormone);
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 changes to the workplace environment, if indicated;
   5. providing counselling regarding psychosocial stresses, if indicated.