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Infertility in women

Last reviewed: 5 Aug 2025
Last updated: 06 Dec 2024

Summary

Definition

History and exam

Key diagnostic factors

  • history of prior pelvic surgery
  • irregular menstrual cycles
  • hirsutism
  • acne
  • palpable uterine abnormalities
  • adnexal abnormalities
  • galactorrhea
Full details

Other diagnostic factors

  • dyspareunia
  • cul de sac abnormalities
Full details

Risk factors

  • age >35 years
  • history of sexually transmitted infection
  • very high body fat
  • very low body fat
  • cigarette smoking
  • autoimmune disease
  • history of appendicitis
  • history of cesarean or instrumental vaginal delivery
  • psychiatric disease
  • substance misuse
  • alcohol consumption
  • caffeine consumption
  • occupational or environmental exposures
  • stress
Full details

Диагностические исследования

Исследования, которые показаны в первую очередь

  • semen analysis
  • luteal-phase progesterone
  • urinary luteinizing hormone (LH)
  • transvaginal ultrasound scan
  • chlamydia antibody testing
  • hysterosalpingogram
  • hysterosalpingo-contrast sonography (HyCosY)
  • basal follicle-stimulating hormone (FSH)
  • saline infusion sonogram
  • antral follicle count
  • serum anti-Müllerian hormone (AMH)
Полная информация

Tests to avoid

  • postcoital test
  • immunologic test
  • thrombophilia test
Полная информация

Исследования, проведение которых нужно рассмотреть

  • serum LH
  • serum estradiol
  • free serum testosterone
  • serum TSH
  • celiac disease testing
  • serum prolactin
  • 3-dimensional ultrasonography
  • pelvic MRI
  • laparoscopy and hysteroscopy
  • karyotyping
Полная информация

Алгоритм лечения

Острый

with underlying or associated medical condition

ПРОДОЛЖЕНИЕ

anovulatory

tubal

endometriosis- or adenomyosis-related

age-related

damaged/missing uterus

endometrial polyps or uterine septum

unexplained

Составители

Авторы

Andrew Drakeley, MBChB, MD, FRCOG

Consultant Gynaecologist

Hewitt Fertility Centre

Liverpool Women's Hospital

Liverpool

UK

Раскрытие информации

AD is Director and stock holder of IVF 2.0 and Horizon Fertility. AD is an advisor to TMRW Life Sciences and Cambridge Clinical Laboratories, and has received conference attendance support from Ferring, Merck, IBSA, and Theramex Pharma.

Lewis Nancarrow, MD, MRCOG

Subspecialty Trainee in Reproductive Medicine

Hewitt Fertility Centre

Liverpool Women's NHS Foundation Trust

Liverpool

UK

Раскрытие информации

LN has been reimbursed for conference attendances by Ferring and for presenting at a fertility nurses conference by IBSA.

Выражение благодарностей

Dr Andrew Drakeley and Dr Dr Lewis Nancarrow would like to gratefully acknowledge Dr Daphne Chong, Dr Jane A. Stewart, and Dr Jared C. Robins, previous contributors to this topic.

Раскрытие информации

DC declares that she has no competing interests. JAS is a past Chair of the British Fertility Society; she is also the head of a large NHS fertility service. JCR declares that he has no competing interests.

Рецензенты

Daniel Williams, MD

Professor of Clinical Obstetrics and Gynecology

University of Cincinnati College of Medicine

Cincinnati

OH

Раскрытие информации

DW declares that he has no competing interests.

Mira Aubuchon, MD

Assistant Clinical Professor

Division of Reproductive Endocrinology

University College of Medicine

Cincinnati

OH

Раскрытие информации

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

Раскрытие информации

SD declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

National Institute for Health and Care Excellence. Fertility problems: assessment and treatment. Sep 2017 [internet publication].Полный текст

European Society of Human Reproduction and Embryology. Unexplained infertility: guideline of European Society of Human Reproduction and Embryology. 2023 [internet publication].Полный текст

Buckett W, Sierra S. The management of unexplained infertility: an evidence-based guideline from the Canadian Fertility and Andrology Society. Reprod Biomed Online. 2019 Oct;39(4):633-40.Полный текст  Аннотация

Practice Committee of the American Society for Reproductive Medicine. Evidence-based treatments for couples with unexplained infertility: a guideline. Fertil Steril. 2020 Feb;113(2):305-22.Полный текст  Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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