Infertility is defined as inability of a couple to conceive naturally after one year of regular unprotected sexual intercourse. It remains a major clinical and social problem, affecting perhaps one couple in six. It affects 13% to 15% of couples worldwide. In addition, infertility is considered also a public problem. It does not affect the couples' life only, but it also affects the health-care services and social environment. The feelings experienced by the infertile couples include depression, grief, guilt, shame, and inadequacy with social isolation. Infertility strikes diverse groups-affecting people from all socioeconomic levels and cutting across all racial, ethnic and religious lines.
For healthy young couples, the probability of getting pregnancy per a reproductive cycle is about 20% to 25%. Their cumulative probabilities of conception are 60% within the first 6 months, 84% within the first year, and 92% within the second year of regular fertility-focused sexual activity.
The causes of infertility can be divided into four major categories:
1) The female factor;
2) The male factor;
3) combined factors;
4) unexplained infertility
It is difficult to assign exact percentage to each of these categories; however, it is generally reported that in approximately 35% of cases, infertility is mainly due to a female factor, in 30% to a male factor, in 15% to abnormalities detected in both partners, and in 25% of cases no diagnosis can be made after a complete investigation.
“A careful history and physical examination can identify symptoms or signs suggesting a specific cause for infertility and thereby help to focus subsequent diagnostic evaluation on the factor(s) most likely responsible”
1) Female Partner Evaluation :
1) Hormonal assessment: AMH, FSH,LH,E2,TSH, Prolactin
2) Routine blood tests
3) Transvaginal Ultrasound, Saline infusion sonography (SIS), Hysterosalpingography (HSG)
Laparoscopy and Hysteroscopy
2) Male Partner Evaluation :
Semen Analysis & Semen Culture
1) Hormonal assessment: FSH, LH, Testosterone, TSH, Prolactin
2) Genetic assessment : Karyotyping, Y chromosome microdeletion
3) Surgical Sperm Retrieval: PESA, TESA, TESE