Subfertility

Published on 02/03/2015 by admin

Filed under Basic Science

Last modified 02/03/2015

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51

Subfertility

Subfertility is defined as the failure of a couple to conceive after one year of regular, unprotected intercourse. A full clinical history obtained prior to physical examinations should seek information about previous pregnancies, contraceptive practice, serious illnesses, past chemotherapy or radiotherapy, congenital abnormalities, smoking habits, drug usage, sexually transmitted disease and the frequency of intercourse. Physical examination should look for indications of hypothalamic–pituitary or thyroid disorders, Cushing’s syndrome, galactorrhoea and hirsutism. In the male, semen analysis should detail volume, sperm density, motility and the presence of abnormal spermatozoa.

In the female, endocrine abnormalities are found in one-third of patients. Hormone dysfunction is a very rare cause of male subfertility. In some couples no cause can be identified.

Endocrine investigations in the subfertile woman

The investigation of the infertile female depends on the phase of the menstrual cycle. If there is a regular menstrual cycle, serum progesterone should be measured in the middle of the luteal phase (day 21). If progesterone is high (>30 nmol/L), the patient has ovulated and there is no need for further endocrine investigations. Other causes of subfertility should be sought. If progesterone is low (<10 nmol/L), ovulation has not occurred.

In women who present with irregular or absent menstruation (oligomenorrhoea or amenorrhoea) or who are not ovulating, hormone measurements may be diagnostic. A protocol for investigation is shown in Figure 51.1. Measurement of oestradiol and gonadotrophin concentrations may detect primary ovarian failure or polycystic ovarian disease. Measurement of prolactin, and androgens, may also assist.

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