Module 3: Toxicology - Section 18: Reproductive Health Disorders in the Workplace

TOX 18.5 Reproductive Health Assessment

4. REPRODUCTIVE HEALTH ASSESSMENT:

The medical assessment of a patient with suspected exposure to a reproductive hazard follows the standard components of history taking, physical examination, and laboratory investigations. In addition, special consideration is needed in the evaluation, communication, and management of reproductive risk for the patient.

4.1 Medical evaluation:

In the clinical setting, infertility is defined as an inability to conceive after 12 months of unprotected intercourse. Potential causes for infertility in the female include ovulatory dysfunction, tubal or pelvic factors, and uterine or cervical factors. It is estimated that the cause of infertility is a result of:

• male factors in 40% of affected couples;
• female factors in 40-50% of affected couples;
• no known aetiology in 10-20% of affected couples.

For the infertility work-up, the male partner needs to be assessed concurrently with the female. Adverse pregnancy outcomes investigated include spontaneous abortion, stillbirth, prematurity, congenital birth defects, and low birth weight.

4.1.1 Interview:

The patient interview should cover the following areas: demographic data, general medical history, lifestyle habits, work history, and reproductive history (including menstrual function, past pelvic surgeries or gynaecological procedures, pregnancy and birth outcomes, sexually transmitted diseases, contraception, and familial illness).

4.1.2 Physical Examination:

This examination should assess the physical integrity of the genital system and rule out any extraneous mass or structural abnormality.

4.1.3 Laboratory :

A hormonal profile can be obtained for the assessment of potential foetal loss (hCG and LH), ovarian function (progesterone and oestrogen metabolites), and pituitary function (LH and FSH). A wide range of tests and assays are available and need to be selected based on the medical conditions under consideration. Urine samples should be relatively easy to collect for hormonal assays.

Postgraduate Diploma in Occupational Health (DOH) - Modules 3: Occupational Medicine & Toxicology (Basic) by Profs Mohamed Jeebhay and Rodney Ehrlich, Health Sciences UCT is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 2.5 South Africa License. Major contributors: Mohamed Jeebhay, Rodney Ehrlich, Jonny Myers, Leslie London, Sophie Kisting, Rajen Naidoo, Saloshni Naidoo. Source available from here. For any updates to the material, or more permissions beyond the scope of this license, please email healthoer@uct.ac.za or visit www.healthedu.uct.ac.za. Last updated Jan 2007.
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