Summary
Definition
History and exam
Key diagnostic factors
- history of prior pelvic surgery
- irregular menstrual cycles
- hirsutism
- acne
- palpable uterine abnormalities
- adnexal abnormalities
- galactorrhea
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
- autoimmune disease
- history of appendicitis
- psychiatric disease
- substance use
- alcohol consumption
- caffeine consumption
- stress
Diagnostic tests
1st tests to order
- semen analysis
- luteal-phase progesterone
- urinary luteinizing hormone (LH)
- transvaginal ultrasound scan
- hysterosalpingogram
- hysterosalpingo-contrast sonography (HyCosY)
- basal follicle-stimulating hormone (FSH)
- saline infusion sonogram
- antral follicle count
- serum anti-Müllerian hormone (AMH)
Tests to consider
- serum LH
- serum estradiol
- free serum testosterone
- serum TSH
- serum prolactin
- Pelvic MRI
- 3-dimensional ultrasonography
- laparoscopy and hysteroscopy
- karyotyping
Treatment algorithm
with underlying or associated medical condition
anovulatory
tubal
endometriosis-related
age-related
damaged/missing uterus
unexplained
Contributors
Authors
Andrew Drakeley, MBChB, MD, FRCOG
Consultant Gynaecologist
Hewitt Fertility Centre
Liverpool Women's Hospital
Liverpool
UK
Disclosures
AD is Director of IVF 2.0 Ltd and an advisor to Ferring Pharma, TMRW Life Sciences, Cooper Surgical. He has also given sponsored lectures, been involved in research studies, including NIHR grant supported studies, and attended conferences with support from Merck, Gideon-Richter and Pharmasure.
Daphne Chong, MBChB, MRCOG
Subspecialist Fellow in Reproductive Medicine
Hewitt Fertility Centre
Liverpool Women’s Hospital
Liverpool
UK
Disclosures
DC declares that she has no competing interests.
Acknowledgements
Dr Andrew Drakeley and Dr Daphne Chong would like to gratefully acknowledge Dr Jane A. Stewart and Dr Jared C. Robins, previous contributors to this topic.
Disclosures
JAS 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.
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.
Differentials
- Male factor infertility
More DifferentialsGuidelines
- Definition of infertility: a committee opinion
- Recurrent pregnancy loss
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Fertility problems: some reasons
Fertility problems: what treatments work?
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