Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- history of prior pelvic surgery
- irregular menstrual cycles
- hirsutism
- acne
- palpable uterine abnormalities
- adnexal abnormalities
- galactorrhoea
Other diagnostic factors
- dyspareunia
- cul de sac abnormalities
Risk factors
- age >35 years
- history of sexually transmitted disease
- very high body fat
- very low body fat
- cigarette smoking
- auto-immune disease
- history of appendicitis
- psychiatric disease
- substance abuse
- alcohol consumption
- caffeine consumption
- stress
Diagnostic investigations
1st investigations to order
- semen analysis
- luteal-phase progesterone
- urinary luteinising hormone (LH)
- transvaginal ultrasound scan
- hysterosalpingogram
- hysterosalpingo-contrast sonography (HyCosY)
Investigations to consider
- basal follicle-stimulating hormone (FSH)
- serum LH
- serum estradiol
- free serum testosterone
- serum TSH
- serum prolactin
- clomifene challenge
- saline infusion sonogram
- 3-dimensional ultrasonography
- MRI pelvis
- laparoscopy and hysteroscopy
- karyotyping
Emerging tests
- serum inhibin
- antral follicle count
- serum anti-mullerian hormone (AMH)
Treatment algorithm
with underlying or associated medical condition
anovulatory
tubal
endometriosis-related
age-related
unexplained
damaged/missing uterus
Contributors
Authors
Jane A. Stewart, MD, BSc, MBChB, FRCOG
Consultant Gynaecologist
Subspecialist in Reproductive Medicine
Newcastle Fertility Centre
Newcastle upon Tyne
UK
Disclosures
JAS is an honorary secretary of the British Fertility Society; she is also the head of a large NHS fertility service.
Acknowledgements
Dr Jane A. Stewart would like to gratefully acknowledge Dr Jared C. Robins, a previous contributor to this topic. JCR declares that he has no competing interests.
Peer reviewers
Daniel Williams, MD
Professor of Clinical Obstetrics and Gynecology
University of Cincinnati College of Medicine
Cincinnati
OH
Disclosures
DW declares that he has no competing interests.
Mira Aubuchon, MD
Assistant Clinical Professor
Division of Reproductive Endocrinology
University College of Medicine
Cincinnati
OH
Disclosures
MA declares that she has no competing interests.
Stephanie Dahl, MD
Assistant Clinical Professor
Department of Obstetrics and Gynecology
University of North Dakota School of Medicine
Fargo
ND
Disclosures
SD declares that she has no competing interests.
Andrew Drakeley, MBChB, MD, MRCOG, CCST
Consultant Gynaecologist
Subspecialist in Reproductive Medicine
Liverpool Women's NHS Foundation Trust
School of Reproductive and Developmental Medicine
Liverpool
UK
Disclosures
AD declares that he has no competing interests.
Differentials
- Male factor infertility
More DifferentialsGuidelines
- Pregnancy at age 35 or older
- Multiple gestation associated with infertility therapy: a committee opinion
More GuidelinesPatient leaflets
Fertility problems: some reasons
Fertility problems: what treatments work?
More Patient leaflets
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