85% of normal couples conceive within the first year.
In the USA ~ 15% of couples are infertile.
1. Male factor infertility accounts for ~ 35% of infertility
2. Ovulation dysfunction occurs in ~ 15-20% of couples
3. Abnormalities of cervical mucus production or sperm mucus interaction
4. Fallopian tube problems an issue in ~ 30-35% of infertile couples
5. Uterine problems
6. Age of the couple
Infertility management has limited success in treating patients older than 40-42 years of age with the exception of IVF (in vitro fertilization) and donor eggs.
Preconception counseling is critical in the management of the infertile couple.
Involvement often includes consultation with urology, endocrinology and a geneticist. (asrm.org)
Despite thorough investigation the exact cause of ovulatory dysfunction often remains obscure.
Basal body temperature (BBT) recordings provide a simple and inexpensive method for evaluating ovulatory function.
In ovulatory cycles the BBT typically rise 1-3 days after the LH surge which can be tested with in urine samples at home.
Ovulation usually occurs within 48 hours after the detection of the LH surge.
Simple blood tests can evaluate the ovarian reserve which is important with advancing age.
Cervical factor problems are usually addressed with insemination.
Uterine factor problems can be easily evaluated and often treated with success.
Fallopian tube problems may be treated with surgery or be managed with IVF treatment.
Diagnostic laparoscopy plays an important role in evaluation of the infertile woman.
Unexplained infertility often occurs in up to 30% of infertile couples.
The use of fertility pills (clomiphene citrate) is common and relatively safe.
The presence of well trained infertility sub specialists has aided tremendously in infertile patients.