UNDERSTANDING INFERTILITY
WHAT LEADS TO A DIAGNOSIS OF INFERTILITY?
AUTHOR Johanna Archer, VMD, MS, MD
T
hough there have been significant
developments over the last several
decades in the treatment of infertil-
ity, the work-up has remained rela-
tively unchanged during this time.
One of the main fallacies we see
as fertility physicians is the belief
that new technologies can trump a
woman’s age. Unfortunately, this is not so. Older women still have as
many difficulties now at getting pregnant as they did decades ago.
The diagnosis of infertility is described as one year of unprotect-
ed intercourse where the woman is less than 35 years of age, or six
months in a woman older than 35 years with no pregnancy. If the
woman is nearing 40 years of age, then an immediate evaluation
is warranted.
Of course, if the couple describes issues that might impact their
fertility potential then an investigation should be started sooner.
This would include irregular cycles, or a history of endometriosis,
ectopic pregnancy or STDs. Other red flags include cancer treat-
ment for either the patient or her partner, or problems with the
male partner such as erectile dysfunction, vasectomy reversal or a
history of low testosterone. Women who have had a salpingectomy
for an ectopic pregnancy now have a 50% decrease in their fertility
rate, and there is an increased risk of a second ectopic pregnancy
in the contralateral tube.
A thorough history can elucidate many possible problems. The
regularity and intensity of the menstrual cycle can indicate oli-
go-ovulation or endometriosis. If the patient was started on birth
control for menorrhagia, then it is possible she has fibroids. One
episode of chlamydia/gonorrhea can impact tubal function and
repeated episodes are more detrimental. Fatigue, weight gain and
a family history of thyroid disease warrant checking a thyroid stim-
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SEPTEMBER 2019
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