Evaluation and treatment of infertility american family. Women who fail to achieve a successful pregnancy after 12 months of regular, unprotected intercourse should be evaluated with the diagnosis of infertility. The evaluation of female infertility simon m kelly mb chb franzcog, togas tulandi md frcsc facog department of obstetrics and gynecology, mcgill university, montreal, quebec correspondence. Infertility workup for the womens health specialist acog.
Although caring for a patient with infertility is within the scope of practice of apns, this process can be. There are also tests that evaluate how sperm and eggs interact. Description of the national public health action plan. The history can give the physician clues to possible causes of infertility such as an ovulation, fallopian tube disease, endometriosis, male factor infertility and other medical disorders. Download a pdf of this fact sheet here diagnostic testing for female infertility. Infertility and subfertility affect a significant proportion of humanity. An evaluation of a woman for infertility is appropriate for women who have not become pregnant after having 12 months of regular, unprotected intercourse. To study the utility of diagnostic laparoscopy in the evaluation of female infertility. Infertiliy the inability to conceive after 1 year of unprotected intercourse for women below 35 years of age or after 6 months for.
One earlier evaluation conducted in developed countries in the 1980s by who found that 8% of infertility cases were attributable to male factors and 35% to both male and female factors, whereas 37% were attributable to female factors alone and 5% to an. Multiple tests have been proposed for evaluation of female infertility. Male infertility 181 might provide improvement in sperm quality, therapy does not necessarily increase the probability of conception. Who has calculated that over 10% of women are inflicted women who have tried unsuccessfully, and have remained in a stable relationship for five years or more.
Jan 27, 2020 female infertility an easy to understand guide covering causes, diagnosis, symptoms, treatment and prevention plus additional in depth medical information. Infertility is a common condition that has a wide range of causes and treatments. To provide a consistent process for determining the optimal course of evaluation of couples with a reduced capacity to conceive compared to the fertility rates of the general population. Initial fertility evaluation first steps determine the causes of a couples infertility. Male infertility is the primary cause in approximately 25% of cases and contributes to an additional 15% to 25% of cases. Approximately 20% of all infertile couples have more than one disorder causing infertility which emphasizes the importance of. Thus, the purpose of this study was to investigate factors related to the anxiety and depression of female infertility patients. The most common demographic factor associated with female infertility impaired fecundity is advanced age although the probability of pregnancy begins to decline by the mid20s, the slope of decline sharply increases by age 35 9 for example, the prevalence of unexplained infertility infertility with no other documented female or male. Introduction to infertility brigham and womens hospital. Genetic evaluation a substantial number of andrological fertility disorders that used to be described as idiopathic male infertility have a.
Ovulatory factors are suspected when menstrual abnormalities are reported. An infertility evaluation may be offered to any patient who by definition has infertility or is at high risk of infertility. Data available over the past 25 years regarding infertility reveal that, in approximately onethird of cases, significant pathology is found in the man alone, while in 20% of cases, abnormalities are found in both the man and the woman. Evaluation should be initiated after 6 months for women 35 years. This topic will provide an evidencebased approach to the evaluation of female infertility. Evaluation of the uterine causes of female infertility by. Unexplained infertility pathophysiology, evaluation and. Earlier evaluation and treatment may be justified, based on medical history and physical findings and is warranted after 6 months for couples in which the female partner is 35 years old 4 x 4 practice committee of the american society for reproductive medicine. Infertility is defined as the inability to become pregnant after 12 months of regular, unprotected intercourse. About 25% of all infertility is caused by a sperm defect and 4050% of infertility cases have a sperm defect as the main cause, or a contributing cause. Female infertility diagnosis and treatment mayo clinic. The causes of female infertility are problems in the fallopian tubes and the uterus, disorders of menstruation, sexual disorders, age and ovarian failure. An individualized evaluation conducted by a fertility specialist can help ease frustration and worry by providing information, answers and direction as to further diagnosis and treatment. The evaluation of infertility involves an investigation into both male and female disorders that can result in infertility.
In this article, we provide an overview of the etiology and evaluation of. Pdf sonographic evaluation of the pelvic causes of. Because the primary aim of infertility treatment is to achieve pregnancy, mental health care during this treatment is often neglected. Women appear to have a higher rate of infertility related stress than men 7,8. Diagnostic evaluation of the infertile female should be accompanied by evaluation of the male partner.
Further, infertility, being highest in kashmir among various states of india,6 needs an appropriate diagnosis and proper treatment at appropriate time. Furthermore, treatments for infertility can carry health risks for women, men, and their children. To find out different causes of female infertility with diagnostic laparoscopy and their comparative frequency in primary and secondary infertility. The optimal imaging methods and their limitations in the evaluation of each category is described. Learning objectives u define infertility u describe causes of female infertility u describe the evaluation of an infertile couple u discuss the psychosocial issues associated with infertility u prerequisites. An infertility evaluation is usually initiated after one year of regular unprotected intercourse in women under age 35 years and after six months of unprotected intercourse in women age 35 years and older. Almost 15% to 30% of the couples are diagnosed to be suffering from. If a severe sperm defect is discovered, the testing on the female partner should be modified, and therapy can be immediately directed to the sperm problem.
Genetic evaluation a substantial number of andrological fertility disorders that used to be described as idiopathic male infertility have a genetic origin. If over 40 years of age, an even more rapid evaluation is warranted. When to do a full evaluation for infertility the full evaluation for male infertility should include a complete medical and reproductive. Bsc of midwifery, department of reproductive imaging, reproductive biomedicine research center, royan institute for reproductive biomedicine, iranian. The care the couple receives begins with a thorough assessment to determine the possible cause of infertility and to plan appropriate care to ensure the best chance for the couple to have a biological child. Female infertility is a complex problem that should be considered carefully by the government and stakeholders in each country and especially by those countries with demographic problems, in order to find effective interventions and solutions. Up to 20% of women who seek infertility care have an abnormal ovarian reserve test. Infertility is the inability to sustain a pregnancy in a woman with regular 23 times per week unprotected sexual intercourse for a period of 1 year. Approximately 60% of infertility is due to female disorders and 40% is due to male disorders. She tells that a detailed history, general physical examination and local examination is done. If you are less than 35 years old, it is reasonable to try for one year before getting a medical evaluation. Infertility, defined as failure to achieve pregnancy within 12 months of unprotected intercourse or therapeutic donor insemination in women younger than 35 years or within 6 months in women older than 35 years, affects up to 15% of couples. Pdf evaluation of female fertility hormone profile in.
Evaluation of women the etiology of female infertility can be broken down into ovulation disorders, uterine abnormalities, tubal. Some of these tests are supported by good evidence, while others are not. A study on role of hysterosalpingogram hsg in evaluation. To cope with the ups and downs of infertility testing and treatment, consider these strategies. Nearly 40% of women who had ever tried to become pregnant selfreported having had an episode of infertility at some point in their lifetime.
National public health action plan centers for disease. Ultrasound imaging plays a major role in the diagnostic evaluation of infertile women. Age can contribute to infertility because as a woman ages, her fertility naturally tends to decrease. For information on adverse effects in women with infertility of any cause, see comment in option on flushing in women with infertility of any cause, in question on endometriosis. Infertility is a problem that involves both partners. This is the first study to report on the prevalence of and associations with female infertility in the republic of palau, which is an underrepresented population in the public health literature. Currently, about 16 17% couples in industrialised countries will seek medical advice for infertility.
Unexplained infertility is defined as a condition when the results of the standard infertility evaluation procedure including semen analysis, assessment of ovulation, hsg, and, if indicated, tests for ovarian reserve and laparoscopy are found to be normal asrm, 2006. Causes of female infertility continued other causes of female infertility include. We wish success for all of our patients, and we will do everything we can to make your familybuilding dream come true. The evaluation typically starts with a thorough history and physical examination. Women under the age of 35 years should seek infertility evaluation if they have not conceived after 1 year of unprotected intercourse. Time interval of infertility including prior attempts genital injuries, development and toxic exposures medical history major childhood illness and current semen analysis x 2 at least one month apart physical exam. These factors may interfere with embryo implantation and a womans ability to carry pregnancy to term. Causes of infertility in women at reproductive age. The video talks about evaluating the causes of female infertility by dr. Infertility results from female factors about onethird of the time and male factors about onethird of the time. Female infertility common causes leading to female factor infertility include ovulatory, tubaltuboperitoneal, ovarian pathologies, uterine causes, endometriosis, endocrinological, anatomical abnormalities and cervical pathologies. We recommend that both partners attend the female infertility evaluation because infertility can affect one or both partners. The most common causes of female infertility include problems with ovulation, damage to fallopian tubes or uterus, or problems with the cervix. Definitions of infertility and recurrent pregnancy loss.
Dealing with female infertility can be physically and emotionally exhausting. Risk factors of tubal infertility in a tertiary hospital in a lowresource setting. However, the evaluation may be initiated sooner in women with irregular menstrual cycles or known risk factors for infertility, such as. There are many available treatments, which will depend on the cause of infertility. Diagnostic testing is unnecessary if the couple has not attempted to conceive for at least 1 year, unless the woman is age 35 years or older, or if they have a history of a male factor infertility, endometriosis, a tubal factor, diethylstilbestrol des exposure, pelvic inflammatory disease, or pelvic surgery. Although caring for a patient with infertility is within. Dr simon m kelly, mcgill reproductive centre, royal victoria hospital, 687 pine avenue west, montreal, quebec h3a 1a1. Evaluation is the first step to taking full advantage of reproductive potential and timeline. Laparoscopic evaluation of female factors in infertility.
Evaluation of factors associated with the anxiety and. Causes of infertility include male factors, ovulatory dysfunction, uterine abnormalities, tubal obstruction, peritoneal factors, or cervical factors. If youre having trouble getting pregnant, your doctor will help you figure out why, and work with you to find a treatment that. The cause is either unknown or a combination of male and female factors in the remaining cases. This publication addresses these issues, focusing on the public health aspects of infertility detection, prevention, and management. Pelvic examination is of course the cornerstone in infertility evaluation. Although infertility is defined as not becoming pregnant after a year of trying, some couples should be evaluated before one year of trying has passed. The uncertainty of infertility testing and treatments can be difficult and stressful. Pathophysiology, evaluation and treatment will be an invaluable resource for all clinicians and scientists working in the fields of reproductive medicine and infertility. Female infertility an overview sciencedirect topics.
Lindsay, md, saint louis university family medicine residency, belleville, illinois. Factors contributing to female infertility are subdivided. Local factors in the uterus and cervix, including uterine septum, uterine fibroids and endometriosis. Educational objectives at the conclusion of this educational activity, participants should be able to. Diagnostic evaluation for infertility should include a comprehensive history and physical exam. Evaluation of women with infertility womens healthcare. Female infertility causes can be difficult to diagnose. Infertility evaluation coastal fertility specialists sc.
Studies have also found that greater than half of the women receiving infertility treatment feel that infertility is the most stressful experience of their lives 7,9. Hysterosalpingography should be offered to screen for uterine and tubal abnormalities in women with infertility who have no history of pelvic infections. However, the inability to conceive children is stressful for couples throughout the world. When couples cannot achieve pregnancy, they often seek health care from medical and nursing specialists. Men and women have suffered from infertility, a stressful condition for many couples, since the dawn of history. Study was done to find the role of hsg in evaluation of female infertility material and methods. Evaluation of the uterine causes of female infertility by ultrasound.
Evaluation and subsequent successful treatment of this condition is a very. Evaluation may be initiated sooner in patients who have risk factors for infertility or if the female partner is older than 35 years. Women older than 35 years should receive an expedited evaluation and undergo treatment after 6 months of failed attempts to become pregnant or earlier, if clinically indicated. Evidencebased care for couples with infertility journal. Mar 01, 2015 evaluation and treatment of infertility this is a corrected version of the article that appeared in print. This period is reduced to six months if the female partner is aged 35 years. Infertility is defined as the inability to achieve pregnancy after one year of regular, unprotected intercourse. Nov 11, 2010 although there is no evidence of a major change in the prevalence of female infertility, many more couples are seeking help than previously. Management of infertility effective health care program.
Hysterosonography is a more complicated type of ultrasound that involves putting. It is our goal that you feel hope the first time you step through our doors at nfc. Evaluation of female fertility hormone profile in women with primary and secondary infertility article pdf available in international journal of science and research ijsr 410. Causes, treatment and prevention what causes female infertility. A total of 50 primary infertility and secondary infertility patients were examined to evaluate the female infertility by using hsg at modern government maternity hospital, hyderabad from june 20014 to.
Eliminating psychological stress may also be necessary for successful infertility treatment. Further evaluation of the male partner should also be considered in couples with unexplained infertility and in couples in whom there is a treated female factor and persistent infertility. Infertility clinical guideline standard infertility workup guideline purpose. We recommend that you make an appointment after unsuccessfully trying to conceive for 6 to 12 months, or sooner if you have irregular periods or if you already know there is some infertility issue. Infertility is a common condition, affecting 15% of couples trying to conceive. Female infertility symptoms and causes mayo clinic. The infertility evaluation includes an assessment of both the female and the male partner to discern the factors. Thoughtful and enlightening, unexplained infertility. Identify essential elements of the personal and family history and physical examination in the evaluation of a woman with infertility. An evaluation of infertility among women in the republic of. Several ultrasound procedures have been used as an investigation method for the pelvic causes of infertility.