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  • Both male and female evaluation are needed to reach diagnosis.
  • Male partner:
    • History
    • Semen analysis
    • If semen analysis abnormal, referral to urology, endocrine evaluation, and karyotyping in severe cases
    • State-mandated infectious disease panel if treatment includes intrauterine insemination or in vitro fertilization
  • Female partner:
    • History, confirm ovulation
    • Physical exam to assess cervix, uterus, and adnexa for pathology
    • Cycle day 3 blood work and ultrasound to assess ovarian reserve
    • Hysterosalpingogram to evaluate uterine cavity and fallopian tubes
    • Possible saline sonogram to evaluate uterine cavity
    • Laparoscopy to assess endometriosis when indicated
    • State-mandated infectious disease panel if undergoing in vitro fertilization

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The number of infertility visits has increased over the past decades. In some cases, couples have voluntarily delayed childbearing in favor of establishing careers and may experience an age-related decline in fertility. There have been significant advances in assisted reproductive technologies (ART), from improved embryo culture media to intracytoplasmic sperm injection (ICSI) and preimplantation genetic diagnosis (PGD), which have resulted in remarkable increases in in vitro fertilization–embryo transfer (IVF-ET) pregnancy rates. These advances coupled with increasing public awareness and acceptance of ART have spurred women or couples with infertility to seek medical care.

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Definition

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Infertility is defined as the inability of a couple to conceive within 1 year. Sterility implies an intrinsic inability to achieve pregnancy, whereas infertility implies a decrease in the ability to conceive and is synonymous with subfertility. Primary infertility applies to those who have never conceived, whereas secondary infertility designates those who have conceived at some time in the past.

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Fecundity is the probability of achieving a live birth in 1 menstrual cycle. Fecundability is expressed as the likelihood of conception per month of exposure. Fertility, as well as infertility, of a woman or couple is best perceived as fecundability, as few infertile patients are sterile. It also allows for a direct comparison of treatment options over a more functional time frame.

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The prevalence of women diagnosed with infertility is approximately 13%, with a range from 7 to 28%, depending on the age of the woman. It has remained stable over the past 40 years; ethnicity or race appears to have little effect on prevalence. However, the incidence of primary infertility has increased, with a concurrent decrease in secondary infertility, most likely as a result of social changes such as delayed childbearing.

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In normal fertile couples having frequent intercourse, the fecundability is estimated to be approximately 20–25%. Approximately 85–90% of couples with unprotected intercourse will conceive within 1 year. Sterility affects 1–2% of couples.

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Infertility can be due to either partner or both. Overall, an etiology for infertility can be found in 80% of cases with an even distribution of male and female factors, including couples with multiple factors. A primary diagnosis of male factor is made in approximately 25% of cases. Ovulatory dysfunction and tubal/peritoneal factors comprise the majority of female factor ...

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