Identifying and Treating Infertility

Infertility is generally defined as failure to conceive after twelve months of unprotected intercourse. Approximately 85 to 90 percent of healthy young couples conceive within one year, with most of these pregnancies occurring within six months. Therefore, infertility affects approximately ten to fifteen percent of reproductive age couples. Using this definition, a U.S. survey in 2002 revealed that approximately 7.4 percent of married women age fifteen to forty-four, or about 2.1 million women were infertile. The same survey revealed that the incidence of infertility increases with age as 11 percent of childless married women age 15-29 had infertility compared with 17 percent of those age 30 to 34, with 23 percent of those age 35 to 39, and 27 percent of those age 40 to 44. The causes of infertility in general can be divided into male and female factors.

In a review of several reports containing more than 14,000 infertile couples. The primary diagnosis includes ovulatory disorders (27%), abnormal semen parameters (25%), tubal disease (22%), endometriosis (5%) unexplained infertility (17%) and other causes (4%). These findings can be grouped into five major factors:

  1. Abnormalities in the production of competent oocytes (ovulatory factor or decreased ovarian reserve with depletion of number of remaining oocytes.)
  2. Abnormalities in the Fallopian tubes, uterine cavity, cervical canal, and other pelvic factors affecting transport of the sperm, oocyte, and embryo.
  3. Abnormalities in implantation of the embryo and defects in embryo development.
  4. Abnormalities of production of sperm (male factor).
  5. Other general conditions including immunologic factors which can affect oocytes, sperm, interaction between sperm and egg, embryo development, and implantation.

The initial and standard components of the infertility evaluation includes a semen analysis, documentation of ovulation (blood test-sonogram), and documentation of tubal patency usually by Hysterosalpingogram (HSG) or Laparoscopy if needed. Depending on couples medical history and physical examination findings, other blood test and different hormones assays or other radiologic tests including ultrasound, CT scan or MRI of the abdomen or pituitary gland and brain may be needed.

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