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Infertility

Last updated: September 24, 2021

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Infertility is generally defined as the inability to achieve pregnancy despite regular unprotected sex after at least one year in women under 35 years of age and after 6 months in women 35 years of age and over. Sperm disorders (e.g., impaired motility, reduced count) are the most common cause of male infertility, while anovulation and impaired fallopian tube motility are the prevalent causes of female infertility. Diagnosis involves the assessment of both the male and the female partner to determine the underlying causes. Commonly performed tests include semen analysis, hormone tests for assessment of ovulatory function, and evaluation of tubal patency. Treatment depends on the underlying cause, with conservative measures including sex hormone substitution and clomiphene citrate or gonadotropins to stimulate ovulation. Surgery is indicated in the presence of structural abnormalities (e.g., tubal adhesions, varicocele). In vitro fertilization is a potential option to facilitate conception in the light of male or female infertility.

Infertility overview
Female infertility Male infertility
Ovary-related factors Tubal/pelvic factors Cervical factors Uterine factors
Etiology
Diagnostics
Treatment
  • Infertility: inability to achieve pregnancy after 12 months of unprotected sex in women < 35 years and 6 months in women ≥ 35 years of age [1][2]
    • Primary infertility: infertility in persons who have never achieved pregnancy
    • Secondary infertility: infertility in persons who have previously achieved at least one pregnancy
  • Recurrent pregnancy loss: the inability of a woman to carry to live birth even if conception is possible (e.g., due to uterine myomas, antiphospholipid syndrome)
  • Infertility affects approx. 10–15% of couples of reproductive age. [3]
  • Approx. 5% of women in the US aged 15–44 years old are infertile. [4]
  • Approx. 5–10% of men in the US aged 15–44 years old are infertile. [5][6]

Epidemiological data refers to the US, unless otherwise specified.

Female infertility

Male infertility

Female infertility may manifest with symptoms of anovulation (e.g., amenorrhea, irregular menses).

Diagnostics [2]

Treatment [2][7][8][9]

Ovarian hyperstimulation syndrome (OHSS) [11][12]

Diagnostics

Treatment

Treatment of underlying cause (see Etiology above).

  1. Infertility Workup for the Women’s Health Specialist. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/06/infertility-workup-for-the-womens-health-specialist. Updated: June 1, 2019. Accessed: June 25, 2021.
  2. Infertility Definitions and Terminology. http://www.who.int/reproductivehealth/topics/infertility/definitions/en/. Updated: June 28, 2017. Accessed: June 28, 2017.
  3. Brenner S, Miller JH, Broughton WJ. Encyclopedia of Genetics. Elsevier ; 2002
  4. FastStats Homepage - Reproductive Health - Infertility. https://www.cdc.gov/nchs/fastats/infertility.htm. Updated: July 15, 2016. Accessed: June 28, 2017.
  5. National Health Statistics Reports, Number 51, April 12, 2012 - Fertility of Men and Women Aged 15–44 Years in the United States: National Survey of Family Growth, 2006–2010.
  6. Agarwal A, Mulgund A, Hamada A, Chyatte M. A unique view on male infertility around the globe. Reprod Biol Endocrinol. 2015 . doi: 10.1186/s12958-015-0032-1 . | Open in Read by QxMD
  7. Tarlatzis BC. GnRH antagonists in ovarian stimulation for IVF. Hum Reprod Update. 2006; 12 (4): p.333-340. doi: 10.1093/humupd/dml001 . | Open in Read by QxMD
  8. Weiss JM, Ludwig M, Ortmann O, Diedrich K. GnRH antagonists in the treatment of infertility.. Ann Med. 2003; 35 (7): p.512-22.
  9. Orvieto R, Meltzer S, Rabinson J, Zohav E, Anteby EY, Nahum R. GnRH agonist versus GnRH antagonist in ovarian stimulation: the role of endometrial receptivity. Fertil Steril. 2008; 90 (4): p.1294-1296. doi: 10.1016/j.fertnstert.2007.10.022 . | Open in Read by QxMD
  10. Johnson NP. Metformin use in women with polycystic ovary syndrome.. Annals of translational medicine. 2014; 2 (6): p.56. doi: 10.3978/j.issn.2305-5839.2014.04.15 . | Open in Read by QxMD
  11. Kumar P, Sait SF. Ovarian hyperstimulation syndrome. J Hum Reprod Sci.. 2011 . doi: 10.4103/0974-1208.86080 . | Open in Read by QxMD
  12. Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline Practice Committee of the American Society for Reproductive Medicine.