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Infertility affects 10-15% of couples. The prevalence of infertility is 33% in those aged 35-39, and 50% after age 40. With evaluation and treatment, at least 50% of infertile couples will become pregnant. Infertility is defined as the failure of a couple to conceive after one year of frequent intercourse.
Male factors account for 35%, tubal or pelvic pathology accounts for 35%, ovulatory dysfunction for 15%, cervical or anatomic causes 5%, and 10% of cases remain unexplained.
Clinical Evaluation of Infertility
Fertility History. Determine the couple's ages, Infertility previous pregnancies, length of time attempting, conception, occupations, and use of tobacco, alcohol, or drugs. Determine frequency and technique of intercourse, use of lubricants (which can be spermicidal), and presence of dyspareunia. Sex selection methods are used to determine the sex of the fetus before birth..
Initial History for the Male Partner includes a sexual development history, history of prior paternity, exercise habits, frequency and volume of ejaculation, exposure to radiation or gonadal toxins, STD history, urologic surgery, medications, and history of mumps.
Initial History for the Female Partner includes history of pelvic inflammatory disease, galactorrhea, pelvic pain, infertile gynecologic surgery, IUD use, DES exposure, and hirsutism.
Menstrual cycle length and regularity and indirect indicators of ovulation such as Mittelschmerz, mid-cycle cervical mucus change and premenstrual molimina should be assessed.
Symptoms of hyperthyroidism, hypothyroidism, hot flashes, weight loss, dieting, and severe stress should ascertain sex selection.