Infertility in women

Last reviewed: 26 Apr 2022
Last updated: 15 May 2020

Summary

Definition

History and exam

Key diagnostic factors

  • history of prior pelvic surgery
  • irregular menstrual cycles
  • hirsutism
  • acne
  • palpable uterine abnormalities
  • adnexal abnormalities
  • galactorrhea
More key diagnostic factors

Other diagnostic factors

  • dyspareunia
  • cul de sac abnormalities
Other diagnostic factors

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 abuse
  • alcohol consumption
  • caffeine consumption
  • stress
More risk factors

Diagnostic investigations

1st investigations to order

  • semen analysis
  • luteal-phase progesterone
  • urinary luteinizing hormone (LH)
  • transvaginal ultrasound scan
  • hysterosalpingogram
  • hysterosalpingo-contrast sonography (HyCosY)
More 1st investigations to order

Investigations to consider

  • basal follicle-stimulating hormone (FSH)
  • serum LH
  • serum estradiol
  • free serum testosterone
  • serum TSH
  • serum prolactin
  • clomiphene challenge
  • saline infusion sonogram
  • 3-dimensional ultrasonography
  • MRI pelvis
  • laparoscopy and hysteroscopy
  • karyotyping
More investigations to consider

Emerging tests

  • serum inhibin
  • antral follicle count
  • serum anti-mullerian hormone (AMH)

Treatment algorithm

ACUTE

with underlying or associated medical condition

ONGOING

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.

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