Infertility is defined as failure to conceive after one year of unprotected intercourse.
Most couples have than one factor.
Genital or pelvic infections (e.g., pelvic inflammatory disease, Chlamydia, Gonocorrhea) are often associated with an obstruction of reproductive tract. Other disorders include cervical dysplasia, dysmenorrhea, chronic salpingitis, and endometriosis.
Endocrine dysfunction (e.g., hypothyroidism, hypogonadism, abnormal puberty, hyperprolactinemia, hypopituitarism) often associated with abnormalities of ovulation or spermatogenesis.
Sexual dysfunction (e.g., premature ejaculation) may contribute to the problem
Anovulatory cycles are frequently irregular, without premenstrual symptoms nor dysmenorrhea. Some patients may have features (e.g., hirsutism) suggestive of polycystic ovarian syndrome.
Endometriosis is often associated with cyclic premenstrual pain and dysmenorrhea.
Infertility may also be due to autoimmune disease (anti-sperm antibodies). Current medical research focuses on the therapeutic action of prostaglandins in infertility.
Semen analysis is usually the first test. The post-coital test examines cervical mucus after intercourse during the fertile period for the number of sperm, their movement and direction.
Basal body temperature charting assesses ovulation and adequacy of the luteal phase of menstruation. Morning temperature should rise about one degree Fahrenheit at the time of ovulation and remain elevated for 13-14 day.
Serum progesterone levels on day 25-27 of a 28 day cycle assesses ovulation and corpus luteum function. A level of 15 or greater correlates with normal corpus luteum function.
An endometrial biopsy assesses ovulation, function of the corpus luteum, and normalcy of the endometrium.
The following tests are useful to evaluate underlying causes of anovulation or low sperm counts: Thyroid stimulating hormone (TSH) and prolactin (elevations associated with suppressed gonadal function); Testosterone (decreased in primary gonadal failure); Follicle stimulating hormone (FSH) and luteinizing hormone (LH) (elevated in primary gonadal failure, decreased in hypopituitarism).
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