Infertility is defined as a failure of a couple to conceive after 12 months of regular intercourse without the use of contraception in women less than the age of 35 and the inability to conceive after 6 months of regular intercourse in women over the age of 35. Some causes of infertility could be azoospermia where no sperm cells are in the ejaculate, longstanding amenorrhea, or bilateral tubal obstruction. Other causes that are less identifiable are reduced number of sperm cells, oligomenorrhea, partial tubal obstruction.
Infertility evaluation should be undertaken after a couple has been unable to conceive after 12 months of unprotected intercourse unless the women is 35 years or older, evaluation would be initiated after 6 months. The tests would include a semen analysis to assess male factors, menstrual history, assessment of LH surge in urine prior to ovulation, hysterosalpingography to assess tubal potency and uterine cavity, serum FSH and estradiol levels. Additional tests may be warranted in some couples that would include pelvic ultrasound for uterine myomas and ovarian cysts, laparoscopy to identify endometriosis or other pelvic pathology, assessment of ovarian reserve in women over the age of 35, and assessment for thyroid function.
Once the cause of infertility is identified, therapy is initiated. Lifestyle modifications to improve fertility should be undertaken such as smoking cessation, reducing excessive caffeine intake and alcohol consumption and appropriate timing and frequency of coitus. Therapeutic interventions can also be beneficial and may involve drug therapy, surgery, and/or IVF and intrauterine insemination. Women who undergo infertility therapies have a small but statistically significant increase in risk of pregnancy complications including preterm birth.