Infertility

Infertility-

-Infertility is defined as a couple that has failed to conceive after 12 months of intercourse without contraception in women that are less than 35 years old

-Infertility is also defined as a couple that has failed to conceive after 6 months of intercourse without contraception in women that are greater than 35 years old

-Infertility is a disorder viewed as a couple disorder rather than a single disorder

-Major causes of infertility include male factors, ovulatory dysfunction, tubal damage, endometriosis, coital problems, cervical factors, and unexplained

-Approximately one fourth of the time is due to male factors such as hypogonadism, post-testicular defects, and seminiferous tubule dysfunction

-Infertility work up is most easily started with a semen analysis.  It tends to be the cheapest and is high yield

-Next step in infertility work up should be menstrual history, assessment of LH surge prior to ovulation, luteal phase progesterone

-If above work up does not provide any answers, a hysterosalpingography should be performed to assess tubal patency and the uterine cavity

-May also want to include day 3 serum FSH and estradiol levels

-Pelvic ultrasound then should be considered to assess for uterine fibroids and ovarian cysts

-Laparoscopy should also be considered if above workup does not provide any answers to exclude endometriosis or other pelvic pathology

-Assessment of thyroid function is also helpful in infertility workup

-If the cause of infertility is identified, corrective action may be able to be taken.

-If woman not ovulating, clomiphene is a consideration

-Males with low sperm count should be evaluated by a urologist

-Treatment for male and female infertility may involve drug therapy, surgery, and or procedures such as intrauterine insemination or in vitro fertilization

-Lifestyle modifications such as smoking cessation, reducing excessive caffeine and alcohol consumption, and appropriate timing of coitus