II. Definition

  1. No conception in 6 months in women over age 35 years
  2. No conception in 1 year without Contraception
    1. Primary Infertility: Nulligravida
    2. Secondary Infertility: Prior pregnancies

III. History

  1. History taken with both partners present
  2. Prior Pregnancy and outcomes
  3. General Factors
    1. Age
    2. Previous pregnancies
    3. Number of contiguous months attempting conception
  4. Symptoms of Sexually Transmitted Disease
    1. Vaginal Discharge
    2. Dysuria
    3. Abdominal Pain
    4. Fever
  5. Medications and substances
  6. Toxin exposures
  7. Menstrual History
  8. Sexual History
    1. Timing of intercourse in Menstrual Cycle
    2. Frequency of intercourse
      1. Optimally every day or every other day in Ovulation
    3. Lubricant use (spermatotoxic)
    4. History of Impotence
    5. Dyspareunia
    6. Technique

IV. Exam

  1. Breast Exam
    1. Breast formation
    2. Galactorrhea
  2. Genitourinary Exam
    1. Uterine masses
    2. Vaginal Discharge
  3. Endocrine (Hyperandrogenism)
    1. Hirsutism
    2. Acne Vulgaris
    3. Clitoromegaly

V. Causes

VI. Evaluation: Male Factor

  1. See Male Infertility
  2. Prior conceived children
  3. History of testicular surgery
  4. History of testicular infection (Mumps)
  5. Semen Analysis
  6. Test for Sexually Transmitted Disease
    1. Mandatory for in vitro fertilization

VII. Evaluation: Female factor

  1. History related to Infertility Causes
  2. Confirm Ovulation
    1. Basal Body Temperature
    2. Urine Luteinizing hormone
  3. Evaluate for Anovulation causes
    1. Follicle Stimulating Hormone
    2. Serum Prolactin
    3. Thyroid Stimulating Hormone
  4. Evaluate for Premature Ovarian Failure (age >35)
    1. Serum Follicle Stimulating Hormone on Day 3 of cycle
      1. Increased FSH >15-29 IU/L on day 3 suggests decreased likelihood of conception
    2. Serum Estradiol on Day 3 of cycle
    3. Clomiphene Citrate (Clomid) challenge
    4. Transvaginal Ultrasound (assess follicle count)
  5. Consider Hyperandrogenism
    1. Serum 17a-Hydroxyprogesterone
    2. Serum Testosterone
  6. Assess tubal patency
    1. Transvaginal Ultrasound
    2. Hysterosalpinography
    3. Consider laparoscopy

VIII. Management

  1. Treat specific conditions if present
    1. Hyperprolactinemia
    2. Polycystic Ovary Syndrome (PCOS)
      1. Metformin (Glucophage)
      2. Laparoscopic Ovarian Drilling
    3. Tubal disease
      1. Tubal repair surgery
    4. Endometriosis
      1. Laparoscopic ablation
    5. Male Infertility
      1. Treat cause (e.g. Varicocele Repair)
      2. Artificial Insemmination, Intrauterine insemination
  2. Ovulatory Dysfunction management
    1. Clomiphene Citrate (Clomid)
      1. Use clomiphene in combination with Metformin if PCOS is present to improve efficacy in stimulating Ovulation
        1. Lord (2003) BMJ 327: 951 [PubMed] (or open in [QxMD Read])
    2. Gonadotropins (for central Hypogonadism)
  3. Unexplained and refractory Infertility
    1. Ovulatory Dysfunction management (as above)
    2. Intrauterine insemination
    3. In-Vitro Fertilization

IX. Prognosis

  1. Overall fertility rate with treatment: 50%
  2. Predictors of lower success rate
    1. Tubal causes of Infertility (20% fertility rate)
    2. Severe Endometriosis (17% fertility rate)
    3. Longer duration of Infertility
    4. No prior fertility history
    5. Women over age 30-35 years
  3. Reference
    1. Collins (2004) Hum Reprod Update 10:309-16 [PubMed] (or open in [QxMD Read])

Images: Related links to external sites (from Google)

Ontology: Infertility (C0021359)

Definition (NCI) Inability to conceive for at least one year after trying and having unprotected sex. Causes of female infertility include endometriosis, fallopian tubes obstruction, and polycystic ovary syndrome. Causes of male infertility include abnormal sperm production or function, blockage of the epididymis, blockage of the ejaculatory ducts, hypospadias, exposure to pesticides, and health related issues.
Definition (MEDLINEPLUS)

Infertility means not being able to become pregnant after a year of trying. If a woman keeps having miscarriages, it is also called infertility. Lots of couples have infertility problems. About a third of the time, infertility can be traced to the woman. In another third of cases, it is because of the man. The rest of the time, it is because of both partners or no cause is found.

Drugs or surgery are common treatments. Happily, two-thirds of couples treated for infertility go on to have babies.

National Women's Health Information Center

Definition (MSH) Inability to reproduce after a specified period of unprotected intercourse. Reproductive sterility is permanent infertility.
Concepts Disease or Syndrome (T047)
MSH D007246
SnomedCT 8619003, 289179008, 162186008
English Infertility, INFERTILITY, Infertility, NOS, unable to get pregnant, inability to conceive, inability to conceive (symptom), inability to conceive (infertility), infertility, Fertility, Infertility NOS, Infertility [Disease/Finding], Unable (to);conceive, get pregnant unable, unable (to) get pregnant, Unable (to);get pregnant, infertile, Infertile, Cannot achieve a pregnancy, Difficulty conceiving, Infertile (finding), Infertility problem, unable to conceive
Dutch onvruchtbaarheid NAO, infertiliteit, Infertiliteit
French Infertilité SAI, Infertilité
German Unfruchtbarkeit NNB, Infertilitaet, Kinderlosigkeit, Fruchtbarkeitsstörung, Infertilität
Italian Infertilità NAS, Infertilità
Portuguese Infertilidade NE, Infertilidade
Spanish Esterilidad NEOM, Infertile, Infertility problem, infértil (hallazgo), infértil, Infertilidad
Japanese 不妊症NOS, フニンショウ, フニンショウNOS, 不妊性, 不妊, 不妊症
Swedish Barnlöshet
Czech infertilita, Neplodost, Neplodnost NOS
Finnish Hedelmättömyys
Polish Niepłodność
Hungarian Infertilitas, Infertilitas k.m.n.

Ontology: Female infertility (C0021361)

Definition (MEDLINEPLUS)

Infertility is a term doctors use if a woman hasn’t been able to get pregnant after at least one year of trying. If a woman keeps having miscarriages, it is also called infertility. Female infertility can result from physical problems, hormone problems, and lifestyle or environmental factors.

Most cases of infertility in women result from problems with producing eggs. One problem is premature ovarian failure, in which the ovaries stop functioning before natural menopause. In another, polycystic ovary syndrome (PCOS), the ovaries may not release an egg regularly or may not release a healthy egg.

About a third of the time, infertility is because of a problem with the woman. One third of the time, it is a problem with the man. Sometimes no cause can be found.

If you suspect you are infertile, see your doctor. There are tests that may tell if you have fertility problems. When it is possible to find the cause, treatments may include medicines, surgery, or assisted reproductive technologies. Happily, two-thirds of couples treated for infertility are able to have babies.

National Women's Health Information Center

Definition (MSH) Diminished or absent ability of a female to achieve conception.
Concepts Pathologic Function (T046)
MSH D007247
ICD9 628.9, 628
ICD10 N97 , N97.9
SnomedCT 156065009, 156067001, 198472001, 6738008, 156059009, 266679002
English Infertility, Female, Infertility, female, of unspecified origin, FEMALE INFERTILITY, Infertility, female, FEMALE INFERTILITY DISORDERS, Female infertility, NOS, Female infertility NOS, Female infertility, unspecified, female infertility, female infertility (diagnosis), 7-79 FEMALE INFERTILITY DISORDERS, Female infertility NOS (disorder), Infertility female, Infertility, Female [Disease/Finding], infertility female, females infertility, Female Infertility, Female infertility (disorder), infertility; female, Infertility - female, Female infertility, Infertility;F
Dutch vrouwelijke onvruchtbaarheid, vrouwelijke onvruchtbaarheid van niet-gespecificeerde oorsprong, infertiliteit; vrouw, Infertiliteit bij vrouw, niet gespecificeerd, onvruchtbaarheid vrouwelijk, Infertiliteit bij vrouw, Infertiliteit van de vrouw
French Stérilité féminine, Infertilité, chez la femme, d'origine non précisée, Infertilité féminine, Infertilité de la femme
German Infertilitaet der Frau, Infertilitaet, weiblich, unspezifischer Ursprung, Sterilitaet der Frau, nicht naeher bezeichnet, Sterilitaet der Frau, Unfruchtbarkeit der Frau, Impotentia gestandi, Fruchtbarkeitsstörung der Frau, Infertilität, weibliche
Italian Infertilità femminile, di origine non specificata, Infertilità femminile
Portuguese Infertilidade feminina de origem NE, Infertilidade feminina, Infertilidade Feminina
Spanish Esterilidad femenina de origen no especificado, Infertilidad femenina, Infertility - female, Female infertility, Female infertility NOS, esterilidad femenina, SAI (trastorno), esterilidad femenina, SAI, infertilidad femenina (trastorno), infertilidad femenina, SAI (trastorno), infertilidad femenina, SAI, infertilidad femenina, Esterilidad femenina, Infertilidad Femenina
Japanese 女性不妊症、原因不明, ジョセイフニンショウ, ジョセイフニンショウゲンインフメイ, 女性不妊症, 不妊症-女性, 女性不妊
Swedish Barnlöshet hos kvinnor
Czech infertilita ženská, Neplodnost u ženy, Ženská neplodnost, Neplodnost ženská, blíže neurčeného původu
Finnish Naisen hedelmättömyys
Korean 상세불명의 여성 불임증, 여성 불임증
Polish Niepłodność kobieca, Niepłodność żeńska
Hungarian Női infertilitas, női infertilitas, Nem meghatározott eredető nő infertilitas

Ontology: Subfertility (C0729353)

Concepts Disease or Syndrome (T047)
MSH D007246
SnomedCT 313279000, 198471008
Dutch subfertiliteit
French Subfécondité
German Subfertilitaet
Italian Subfertilità
Portuguese Subfertilidade
Spanish Subfertilidad, fertilidad disminuida, subfertilidad (hallazgo), fertilidad disminuida (hallazgo), subfertilidad
Japanese 低妊孕率, テイニンヨウリツ
Czech Subfertilita
English subfertility, Subfertility, Sub-Fertility, Subfertility (finding)
Hungarian Subfertilitas