Diminished or absent ability to conceive and bear offspring. A couple is considered to be experiencing infertility if conception has not occurred after 12 months of sexual activity without the use of contraception. Infertility can have many causes and may be related to factors in the male, female, or both.
EVALUATION OF INFERTILITY IN MEN
Fertility in men requires normal functioning of the hypothalamus, pituitary gland, and testes. Therefore, a variety of different conditions can lead to infertility. The evaluation of male infertility may point to an underlying cause, which can guide treatment. Important steps for curing infertility are:-
History - A mans past health and medical history is important in the process of evaluation. A healthcare provider will ask about childhood growth and development; sexual development during puberty; sexual history; illnesses and infections; surgeries; medications; exposure to certain environmental agents (alcohol, radiation, steroids, chemotherapy, and toxic chemicals); and any previous fertility testing.
Physical examination -A physical examination usually includes measurement of height and weight, assessment of body fat and muscle distribution, inspection of the skin and hair pattern, and visual examination of the genitals and breasts.
Lab testing - Sperm count is a central part of the evaluation of male infertility. This analysis provides information about the amount of semen and the number, motility, and shape of sperm.
A man should avoid ejaculation (sex and masturbation) for two to seven days before providing the semen sample. Ideally, a sample should be collected in a clinician's office after masturbation; if this is not possible, the man may collect a sample at home in a sterile laboratory container or chemical-free condom. The sample should be delivered to the lab within one hour of collection.
Blood tests - Blood tests provide information about hormones that play a role in male fertility. If sperm concentration is low or the clinician suspects a hormonal problem, the clinician may order blood tests to measure total testosterone.
Genetic tests - if genetic or chromosomal abnormalities are suspected, specialized blood tests may be needed to check for the number and structure of the chromosomes as well as absent or abnormal regions of the male chromosomes.
Other tests - If a blockage in the reproductive tract is suspected, a transrectal ultrasound test may be ordered.
EVALUATION OF INFERTILITY IN WOMEN
Although a variety of tests are available for evaluating female infertility, it may not be necessary to have all of these tests. Healthcare providers usually begin with a medical history, a thorough physical examination, and some preliminary tests.
Medical history - A woman's past health and medical history may provide some clues about the cause of infertility. The healthcare provider will ask about childhood development; sexual development during puberty; sexual history; illnesses and infections; surgeries; medications used exposure to certain environmental agents (alcohol, radiation, steroids, chemotherapy, and toxic chemicals); and any previous fertility evaluations.
Menstrual history - Absent menstrual periods usually signals an absence of ovulation, which can cause infertility. Irregular menstrual cycles can be a sign of irregular ovulation; although it does not make pregnancy impossible, it can interfere with the ability to become pregnant.
Physical examination - A physical examination usually includes a general examination, with special attention to any signs of hormone deficiency or signs of other conditions that might impair fertility.
Blood tests - Blood tests can provide information about the levels of several hormones that play a role in female fertility; in women, key hormones are produced by the hypothalamus, the pituitary gland, and the ovaries. These hormones can include follicle-stimulating hormone, estradiol, and antimullerian hormone level to assess how well the ovaries are functioning.
A test to measure the progesterone level is usually performed 20 to 24 days after the first day of a menstrual period.
Basal body temperature - Monitoring of basal body temperature which is measured before getting out of bed in the morning was previously recommended to determine if ovulation occurred.
The test is done while the woman is awake and lying on an x-ray table. Most women experience moderate to severe pelvic cramps when the liquid is injected, but this usually improves after 5 to 10 minutes. The test is usually performed 6 to 10 days after the menstrual period.
Genetic tests - Genetic testing may be recommended if there is a suspicion that genetic or chromosomal abnormalities are contributing to infertility. These tests usually require a small blood sample, which is sent to a laboratory for evaluation.