The second part of the sub-specialty is that of infertility. Often reproductive endocrine problems lead to this. Infertility is now being broken down into many areas. Male factor, female factor and sometimes unexplained.
Female infertility may include problems with ovulation (eg. PCOS), excessive exercise, fallopian tubes, uterus or even as a result of other illnesses.
Male factor infertility is a multiple and varied field. Causes may range from low sperm counts through to blocked vas, systemic illness or anatomical problems. Medications can affect male fertility as can illnesses and many other factors.
I often apply a simple list to questions on infertility.
This simple mnemonic which I call the South CCOOAASSTT principle, gets me through many of the causes of infertility, but of course it could be used anywhere.
C Cervical – Previous surgery and congenital problems with
C Coital (sex) – Not enough and problems with
O Ovulation – Not enough or never
O Other – Covers many other areas such as lifestyle, illnesses and family history.
A Anatomy – Both male and female
A Age – Female age is a significant factor. Male, not so much.
S Sperm – A semen analysis answers most male factor questions
S Sex (Coitus)
T Tubes – Where egg and sperm have to meet to fertilize
T Timing – When coitus takes place is vital
Once I have taken a thorough history from my patients (that means the couple) and I have examined them both, I know in what direction to move forward. Sometimes it is straightforward, i.e. previous vasectomy; sometimes it is not so obvious.