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Last updated: February 15, 2021

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Infertility is defined as the inability of a couple to conceive despite one year of unprotected sex. In many cases, both causes of male and female infertility contribute to a couple being unable to conceive. The most common cause of male infertility is a sperm disorder (e.g., impaired motility, reduced count), whereas in women anovulation and impaired fallopian tube motility are the prevalent causes. Diagnostics focus on assessing both partners for possible causes of infertility. Tests that are commonly performed include semen analysis, hormone tests for assessment of ovulatory function, and evaluation of tubal patency. Treatment focuses on the underlying cause of infertility, e.g., sex hormone substitution and administration of clomiphene citrate or gonadotropins to stimulate ovulation. Surgery is indicated if structural issues (e.g., tubal adhesions, varicocele) are present, while in vitro fertilization is used for causes of both male and female infertility.

  • Infertility: inability of a couple to conceive despite 1 year of unprotected sex
    • Primary infertility: infertility in women who have never been pregnant or in men who have never successfully conceived with a partner
    • Secondary infertility: infertility in women who have previously conceived; infertility in men who have previously induced pregnancy
  • Recurrent pregnancy loss: inability of a woman to carry to live birth even if conception is possible (e.g., caused by uterine myomas, antiphospholipid syndrome)


  • Infertility affects approx. 10–15% of couples of reproductive age.
  • Approx. 5% of women in the US aged 15–44 years old are infertile.
  • Approx. 5–10% of men in the US aged 15–44 years old are infertile.


Epidemiological data refers to the US, unless otherwise specified.

Both sexes

Female infertility

Male infertility

References: [2]

Clinical findings


  1. History of both partners , especially gynecological history
  2. Assess ovulatory function
  3. Assess patency of fallopian tubes and uterus: hysterosalpingography or sonohysterosalpingography
    • Indications: If the initial work-up does not reveal any abnormalities and no history suggestive of tubal obstruction
    • Screen for tubal occlusion and structural uterine abnormalities (e.g., septate uterus, submucous fibroids, intrauterine adhesions)
    • Can also be therapeutic since it removes small adhesions or mucous plugs obstructing the tubal lumen
    • If evidence of intrauterine abnormalities or tubal occlusion → hysteroscopy and/or laparoscopy indicated
  4. Examine cervix: Pap smear and physical exam; testing for antisperm antibodies in cervical mucus (see “Diagnostics” in male infertility below)


Treatment depends on the cause of infertility:


Clinical findings

  • Depend on the underlying condition



Treatment depends on the cause of infertility (see “Etiology” above).


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