Infertility
Infertility is defined as the inability to conceive after 12 months of regular, unprotected intercourse (or 6 months in women > 35 years). It is a multifaceted condition requiring evaluation of both partners.
Primary Etiologies
- Ovulatory Dysfunction (25%): PCOS, hypothalamic amenorrhea, premature ovarian insufficiency (POI).
- Tubal/Peritoneal Factors (20%): Pelvic Inflammatory Disease (PID), endometriosis, prior tubal surgery.
- Male Factor (30–40%): Varicocele, obstruction, hormonal issues, or semen abnormalities.
- Uterine/Cervical Factors (10%): Fibroids, polyps, or intrauterine adhesions (Asherman syndrome).
Basic Diagnostic Workup
| Area | Key Investigation |
|---|---|
| Ovulation | Mid-luteal phase progesterone, Day 3 FSH/Estradiol, AMH (ovarian reserve). |
| Tubal | Hysterosalpingogram (HSG) to assess tubal patency. |
| Male | Semen analysis. |
High-Yield Exam Pearl:
- Unexplained Infertility: Diagnosis reached after standard evaluation is normal. Often managed with ovulation induction (e.g., Letrozole or Clomiphene) and intrauterine insemination (IUI).
- Ovarian Reserve: Anti-Müllerian Hormone (AMH) levels and Antral Follicle Count (AFC) are the most reliable indicators of the quantity of remaining follicles.