Fertility and General Investigation

Infertility is defined as the 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 couple’s life only, but it also affects the health-care services and social environment. The feelings experienced by 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 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.

Types Of Fertility

Primary Infertility:

The couple has never produced a pregnancy

Secondary Infertility:

The woman has previously been pregnant, regardless of the outcome, and now is unable to conceive (History of prior pregnancy including miscarriage or ectopic)

The causes of infertility can be divided into four major categories:

  • The female factor;
  • The male factor;
  • Combined factors;
  • 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”

Female Partner Evaluation :

First -Level Diagnostic Tests

  • Hormonal assessment: AMH, FSH,LH,E2,TSH, Prolactin
  • Routine blood tests
  • Transvaginal Ultrasound, Saline infusion sonography (SIS), Hysterosalpingography (HSG)

Second-Level Diagnostic Tests

  • Laparoscopy and Hysteroscopy

Male Partner Evaluation :

First -Level Diagnostic Tests

  • Semen Analysis & Semen Culture

Second-Level Diagnostic Tests

  • Hormonal assessment: FSH, LH, Testosterone, TSH, Prolactin
  • Genetic assessment : Karyotyping, Y chromosome microdeletion
  • Surgical Sperm Retrieval: PESA, TESA, TESE