Infertility: initial evaluation of a couple failing to conceive

What it is

Infertility is the inability to conceive after one year of regular and unprotected intercourse, and after 6 months in women aged over 35 years. Another page states the same rule as the inability of a sexually active, non-contracepting couple to achieve pregnancy in one year.

Evaluation begins earlier, after 6 months of regular unprotected intercourse, when the woman is over 40 years, has an irregular cycle, has had sexually transmitted diseases, or has cancer.

Causes and risk

The history and examination cover both of the couple.

In the woman: ovulatory problems, pelvic adhesions, tubal blockage, hyperprolactinemia, leiomyoma, endometriosis, advanced age, and a detailed history of coitus and its frequency.

The causes in the female are set out by the part at fault. The ovulatory ones are PCOS, gonadal agenesis, that is Turner syndrome, ovarian cancer, and hypothalamic and pituitary dysfunction such as Sheehan syndrome. The tubal ones are PID and endometriosis. The uterine ones are congenital - septate uterus, bicornuate uterus, uterine didelphys, that is 2 uterus, and Mullerian agenesis - or acquired: submucosal fibroid, adenomyosis, polyp, Asherman syndrome and endometritis. The cervical ones are a low estrogen giving a thick mucus so sperm cannot pass, and cervical stenosis.

In the man: congenital and chromosomal disease such as Klinefelter's, obesity, endocrinopathy, drugs such as androgens, tumor, vascular disease, infiltrative disease, infection, and chemo or radio exposure.