Infertility

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Infertility is an issue of the reproductive male or female, and affects 10% of young adults. It is defined by an inability to conceive after 12 months of unprotected, regular intercourse. However, problems should be anticipated earlier if there is an obvious abnormality, or the female's age is > 35 years. Infertility can result from male or female factors, often present together. 14% of infertility problems remain "unexplained".

In their late twenties, there is a 15% chance of pregnancy/month, with a 15-30% miscarriage rate. Risks of infertility and miscarriage increase with female age. Overall, 65% of people with persistent infertility ultimately conceive.

To maximize the chances for pregnancy, daily or alternate day intercourse is ideal at time of ovulation (e.g., days 11 - 17 of 28 day cycle). Abstaining from ejaculation for > 7 days may reduce sperm quality or number. Sperm can reach the fallopian tube within 5 minutes after intercourse.

History

Female

  • What is the frequency of menstrual bleeding?
  • Are there painful periods?
  • Is there any breast tenderness or bloating?
  • Breast secretions?
  • Weight change, exercise, body hair?
  • Appendicitis, pelvic infection?
  • History of endometriosis?
  • Dilation and curettage (D&C)?
  • Miscarriage/pregnancy loss?

Male

  • Undescended testes?
  • Mumps as adult?
  • Testicular injury?
  • Reversal of vasectomy?
  • Difficulty with erections or urination?

Both

Treatment

  • Intermediate
  • Intrauterine insemination (IUI)
  • Donor sperm
  • Tubal surgery
  • Advanced
  • In-vitro fertilization (IVF)
  • Intra-cytoplasmic sperm injection (ICSI)
  • Embryo freezing after IVF or ICSI
  • Microsurgical Epididymal Sperm Aspiration (MESA)
  • Per-cutaneous Sperm Aspiration (PESA)

Resources