• Credits

  • Section Writer: Dr. Om J Lakhani
  • Section Editor: Dr. Om J Lakhani

• Q. Is the prevalence of infertility on the rise?

  • No
  • The prevalence is stable, but the demand for infertility services is increasing because of increased awareness

• Q. What is the definition of infertility?

  • Inability to conceive despite regular unprotected intercourse for 12 months for women <35 years of age
  • And for six months for women >35 years of age

• Q. What is fecundiblity ?

  • Ability to conceive in one menstrual cycle

• Q. What are the normal fertility in 1 year and fecundity?

  • Normal fertility is around 85% in the first year
  • Of the remaining 15%, around 10% will conceive in the second year, so 95% fertility in 2 years
  • Fecundiblity is 0.25 in the first three months falls to 0.11 in the next 9 months

• Q. What is the distribution of male and female infertility?

  • 37% - female factor
  • 8% - male factore
  • 35% - both
  • 15%  - unexplained

• Q. What is the indication for infertility evaluation?

  • Inability to conceive with 12 months of unprotected intercourse – all otherwise normal women and age <35 years
  • Inability to conceive with six months of unprotected intercourse – all otherwise normal women and age >35 years

• Initiate evaluation in <6 months

  • Women age >40 years
  • Having Endometriosis
  • Having radiation, chemotherapy
  • Oligo-amenorrhea
  • Known or suspected tubal or uterine disease
  • The male partner has testicular surgery, mump orchitis, etc

• Q. Who should be evaluated first – male or female?

  • Both should be evaluated together

• Q. Which are the first line tests done in couples with infertility?

  • Semen analysis
  • Menstrual history, LH surge, and luteal phase progesterone
  • Thyroid function test
  • Day 3 FSH and estradiol
  • HSG for tubal patency

• Q. Which are some additional tests done in select couples?

  • Ultrasound of pelvis for ovarian cysts
  • Laparoscopy for endometriosis
  • Assessment of ovarian reserve for women >35 years- AMH, TVS- antral follicular count, and clomiphene challenge test

• Q. How frequently should intercourse be performed during the fertile period based on the ovulation detection kit?

  • Every 1-2 days

• Q. Do infertile women have an increased risk of complications?

  • Yes
  • Both natural and artificial conception for infertile women is associated with increased risk of LBW and preterm

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