• Clinical science

Infertility

Abstract

Infertility is defined as the inability of a couple to conceive despite one year of unprotected sex. In many cases, both causes of male and female infertility contribute to a couple being unable to conceive. The most common cause of male infertility is a sperm disorder (e.g., impaired motility, reduced count), whereas in women anovulation and impaired fallopian tube motility are the prevalent causes. Diagnostics focus on assessing both partners for possible causes of infertility. Tests that are commonly performed include semen analysis, hormone tests for assessment of ovulatory function, and evaluation of tubal patency. Treatment focuses on the underlying cause of infertility, e.g., sex hormone substitution and administration of clomiphene citrate or gonadotropins to stimulate ovulation. Surgery is indicated if structural issues (e.g., tubal adhesions, varicocele) are present, while in vitro fertilization is used for causes of both male and female infertility.

Definition

References:[1][2]

Epidemiology

  • Infertility affects approx. 10–15% of couples of reproductive age.
  • Approx. 5% of women in the US aged 15–44 years old are infertile.
  • Approx. 5–10% of men in the US aged 15–44 years old are infertile.

References:[3][4][5][6]

Epidemiological data refers to the US, unless otherwise specified.

Female infertility

Etiology

Clinical findings

Diagnostics

  1. History of both partners , especially gynecological history
  2. Assess ovulatory function
  3. Assess patency of fallopian tubes and uterus: hysterosalpingography or sonohysterosalpingography
    • Indications: If the initial work-up does not reveal any abnormalities and no history suggestive of tubal obstruction
    • Screen for tubal occlusion and structural uterine abnormalities (e.g., septate uterus, submucous fibroids, intrauterine adhesions)
    • Can also be therapeutic since it removes small adhesions or mucous plugs obstructing the tubal lumen
    • If evidence of intrauterine abnormalities or tubal occlusion → hysteroscopy and/or laparoscopy indicated
  4. Examine cervix: Pap smear and physical exam; testing for antisperm antibodies in cervical mucus (see “Diagnostics” in male infertility below)

Treatment

Treatment depends on the cause of infertility:

References:[1][2][7][8][9][10]

Male infertility

Etiology

Diagnostics

Treatment

Treatment depends on the cause of infertility (see “Etiology” above).

References:[2][11]

  • 1. Le T, Bhushan V, Chen V, King M. First Aid for the USMLE Step 2 CK. McGraw-Hill Education; 2015.
  • 2. World Health Organization. Infertility Definitions and Terminology. http://www.who.int/reproductivehealth/topics/infertility/definitions/en/. Updated June 28, 2017. Accessed June 28, 2017.
  • 3. Puscheck EE, Lucidi RS. Infertility. In: Infertility. New York, NY: WebMD. http://emedicine.medscape.com/article/274143-overview. Updated August 31, 2016. Accessed June 28, 2017.
  • 4. Centers for Disease Control and Prevention. FastStats Homepage - Reproductive Health - Infertility. https://www.cdc.gov/nchs/fastats/infertility.htm. Updated July 15, 2016. Accessed June 28, 2017.
  • 5. Martinez G, Daniels K, Chandra A. National Health Statistics Reports, Number 51, April 12, 2012 - Fertility of Men and Women Aged 15–44 Years in the United States: National Survey of Family Growth, 2006–2010. url: https://www.cdc.gov/nchs/data/nhsr/nhsr051.pdf Accessed June 28, 2017.
  • 6. Agarwal A, Mulgund A, Hamada A, Chyatte M. A unique view on male infertility around the globe. Reprod Biol Endocrinol. 2015. doi: 10.1186/s12958-015-0032-1.
  • 7. Steward RG, Lucidi RS. Hysterosalpingogram. In: Hysterosalpingogram. New York, NY: WebMD. http://emedicine.medscape.com/article/2111999-overview. Updated November 29, 2016. Accessed June 28, 2017.
  • 8. Tarlatzis BC. GnRH antagonists in ovarian stimulation for IVF. Hum Reprod Update. 2006; 12(4): pp. 333–340. doi: 10.1093/humupd/dml001.
  • 9. Weiss JM, Ludwig M, Ortmann O, Diedrich K. GnRH antagonists in the treatment of infertility. Ann Med. 2003; 35(7): pp. 512–22. pmid: 14649333.
  • 10. Orvieto R, Meltzer S, Rabinson J, Zohav E, Anteby EY, Nahum R. GnRH agonist versus GnRH antagonist in ovarian stimulation: the role of endometrial receptivity. Fertil Steril. 2008; 90(4): pp. 1294–1296. doi: 10.1016/j.fertnstert.2007.10.022.
  • 11. Tritos NA. Kallmann Syndrome and Idiopathic Hypogonadotropic Hypogonadism. In: Griffing GT. Kallmann Syndrome and Idiopathic Hypogonadotropic Hypogonadism. New York, NY: WebMD. https://emedicine.medscape.com/article/122824. Updated October 10, 2016. Accessed May 28, 2018.
last updated 11/19/2018
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