Understanding Infertility and Its Evaluation

Infertility is defined as the inability of a couple to conceive after 12 months of regular, unprotected intercourse. This issue affects approximately 1 in 7 couples, with male factors accounting for about 20% of cases. Notably, around 85% of couples are able to conceive within a year of trying.

For women over the age of 35 or couples with known risk factors, it is generally recommended to seek evaluation if pregnancy has not occurred after six months of trying.

Common Causes of Subfertility

Stress and anxiety are among the most common causes of subfertility. These factors can decrease libido, further complicating the problem, and the treatments and tests offered can also be stressful.

Evaluating Male Fertility

To assess male fertility, a comprehensive evaluation is conducted, including:

Evaluating Male Fertility

1. Medical History

o Childhood growth and development

o Sexual development during puberty

o Sexual history

o Illnesses and infections

o Surgeries

o Medications

o Exposure to environmental agents (alcohol, radiation, steroids, chemotherapy, toxic chemicals)

o Previous fertility testing

2. Physical Examination

o Height and weight

o Skin and hair pattern (loss of facial and body hair may indicate testosterone deficiency)

o Examination of the genitals and breasts (checking for decreased testis size, varicocele, or absent vas deferens)

3. Semen Analysis

o This is a critical test, requiring a sample to be provided in a laboratory within one hour of collection. Ejaculation should be avoided for two to seven days before providing the sample.

4. Hormonal Tests

o FSH, LH, Testosterone, and Prolactin levels may be tested if sperm concentration is low.

5. Additional Tests

o Genetic or chromosomal testing in special cases

o Ultrasound of the testis if sperm count is low

o DNA fragmentation test if semen analysis is abnormal

Evaluating Female Fertility

To assess female fertility, a detailed evaluation is performed, including:

1. Medical History

o Childhood development

o Sexual development during puberty

o Sexual history

o Illnesses and infections

o Surgeries

o Medications

o Exposure to environmental agents (alcohol, radiation, steroids, chemotherapy, toxic chemicals)

o Previous fertility evaluations

2. Menstrual History

o Absent menstrual periods may indicate a lack of ovulation, leading to infertility.

o Oligomenorrhea (irregular menstrual cycles) can signal irregular or absent ovulation.

3. Physical Examination

o General examination

o Signs of hormone deficiency or excess (e.g., facial hair)

o Pelvic examination

4. Blood Tests

o Hormonal tests (FSH, estradiol, AMH) to assess ovarian function

o TSH to test thyroid function

o Prolactin to check for benign pituitary tumors

5. Ovulation Tests

o Blood tests (LH levels, progesterone)

o Basal body temperature monitoring

o Ovulation kits to check LH levels in urine

o Ultrasound follicular monitoring to evaluate follicle development

6. Uterus Evaluation

o 3D ultrasound to identify uterine abnormalities (e.g., uterine septum, fibroids, polyps, structural abnormalities)

7. Fallopian Tube Assessment

o Hysterosalpingogram (HSG): An X-ray test using a liquid dye to outline the uterus and fallopian tubes.

o Sonohysterogram: An ultrasound test with saline infusion to check the tubes.

o Hysteroscopy: A camera inserted through the cervix to view the uterus lining and fallopian tube entry points.

o Laparoscopy: A surgical procedure under general anesthesia to view the uterus, ovaries, and fallopian tubes. It can detect and treat endometriosis and pelvic adhesions

8.Genetic Testing

o In special cases, genetic tests may be recommended, involving a small blood sample.