Fertility and general Investigation

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.

Primary Infertility: No prior pregnancy

Secondary Infertility: History of prior pregnancy including miscarriage or ectopic

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 :

I) First-Level Diagnostic Tests

1) Hormonal assessment: AMH, FSH,LH,E2,TSH, Prolactin

2) Routine blood tests

3) Transvaginal Ultrasound, Saline infusion sonography (SIS), Hysterosalpingography (HSG)

II) Second -Level Diagnostic Tests

Laparoscopy and Hysteroscopy

2) Male Partner Evaluation :

I) First-Level Diagnostic Tests

Semen Analysis & Semen Culture

II) Second -Level Diagnostic Tests

1) Hormonal assessment: FSH, LH, Testosterone, TSH, Prolactin

2) Genetic assessment : Karyotyping, Y chromosome microdeletion

3) Surgical Sperm Retrieval: PESA, TESA, TESE

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