Infertility is classically defined as the failure of a couple to conceive after 12 months of frequent intercourse without use of contraception in women under age 35, and after six months in women over age 35. Fecundability is the probability of achieving a pregnancy in one menstrual cycle.
Eighty to 90 percent of couples will conceive within 12 months of attempting pregnancy. Fecundability progressively decreases over time.
Infertility can be due to male factors, female factors, or factors contributed by both partners. Identifiable male factors include hypogonadism, post-testicular defects, and seminiferous tubule dysfunction. Diagnosable female factors include ovulatory dysfunction, tubal damage, endometriosis, and cervical factor. In some cases, infertility is due to coital problems or is unexplained.
The general consensus among infertility experts is that infertility evaluation should be undertaken for couples who have not been able to conceive after 12 months of unprotected and frequent intercourse, but earlier evaluation can be justified based on medical history and physical findings, and in women over 35 years of age.
Components of the basic infertility evaluation include history and physical examination, semen analysis, menstrual history, laboratory tests, and assessment of the fallopian tubes and uterus using hysterosalpingography, hysteroscopy, ultrasonography, and/or laparoscopy.
Once the cause of infertility is identified, therapy aimed at correcting reversible etiologies and overcoming irreversible factors can be implemented. Therapeutic interventions for treatment of male and female infertility may involve drug therapy, surgery, and/or procedures such as intrauterine insemination or in vitro fertilization.
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