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Infertility in women

Last reviewed: 1 Nov 2024
Last updated: 12 Dec 2023

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 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
Full details

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)
Full details

Tests to consider

  • serum LH
  • serum estradiol
  • free serum testosterone
  • serum TSH
  • serum prolactin
  • Pelvic MRI
  • 3-dimensional ultrasonography
  • laparoscopy and hysteroscopy
  • karyotyping
Full details

Treatment algorithm

ACUTE

with underlying or associated medical condition

ONGOING

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.

  • Infertility in women images
  • Differentials

    • Male factor infertility
    More Differentials
  • Guidelines

    • Definition of infertility: a committee opinion
    • Recurrent pregnancy loss
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  • Patient information

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    Fertility problems: what treatments work?

    More Patient information
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