Medicine Central™ is a quick-consult mobile and web resource that includes diagnosis, treatment, medications, and follow-up information on over 700 diseases and disorders, providing fast answers—anytime, anywhere. Explore these free sample topics:
-- The first section of this topic is shown below --
Definition: failure of a couple to conceive after ≥12 months of regular unprotected intercourse or after ≥6 months if the woman is ≥35 years. Primary: Couple has never been pregnant. Secondary: Couple has been pregnant. Fecundability: the probability of achieving pregnancy in one menstrual cycle
Incidence is the probability of achieving a pregnancy within 1 year. ~85% of couples will conceive within 12 months of unprotected intercourse.
- In the United States, 5–15% of women currently trying to conceive are infertile.
- ~11.5% of married couples between ages 15 and 34 years and 42% between ages 35 and 44 years meet the criteria for being infertile.
- May increase as more women delay childbearing; 20% of women in the United States have their first child >35 years.
Etiology and Pathophysiology
- Most cases multifactorial: Approximately 50% of cases due to female factors (of which 20% are due to ovulatory dysfunction and 30% due to tubal and pelvic pathology); 30% due to male factors; and 20% are of unknown etiology.
- Acquired: Most common cause of infertility in the United States is pelvic inflammatory disease (PID) secondary to chlamydia (1), endometriosis, polycystic ovary syndrome (PCOS), premature ovarian failure, and increased maternal age.
- Diminished ovarian reserve (DOR): low fertility due to low quantity or functional quality of oocytes
- Congenital: anatomic and genetic abnormalities
- Higher incidence of genetic abnormalities among infertile population, including Klinefelter syndrome (47XXY), Turner syndrome (45X or mosaic), and fragile X syndrome
- Y chromosomal microdeletions are associated with isolated defects of spermatogenesis → found in 16% of men with azoo-/severe oligospermia.
- Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation causing congenital bilateral absence of vas deferens (CBAVD)
- Gynecologic history: irregular/abnormal menses, sexually transmitted infections (STIs), dysmenorrhea, fibroids, prior pregnancy
- Medical history: endocrinopathy, autoimmune disease, undiagnosed celiac disease, collagen vascular diseases, thrombophilia, obesity, and cancer
- Surgical history: appendicitis, pelvic surgery, intrauterine surgery, tubal ligation
- Social history: smoking, alcohol/substance abuse, eating disorders, exercise, advanced maternal age
- Medical history: STI, prostatitis, medication use (i.e., β-blockers, calcium channel blocker, antiulcer medication), endocrinopathy, cancer
- Surgical history: orchiopexy, hernia repair, vasectomy with/without reversal
- Social: smoking, alcohol/substance abuse, anabolic steroids, environmental exposures, occupations leading to increased scrotal temperature
Normal diet and exercise, avoid smoking and other substance abuse, prevention of STIs
Commonly Associated Conditions
- Sexual behavior increasing risk for STIs
- Pelvic pathology: endometriosis, ovarian cysts, endometrial polyps, and uterine fibroids
- Endocrine dysfunction (thyroid, glucose metabolism, menstrual cycle abnormalities, prolactin)
- Anovulation is commonly associated with hyperandrogenism and PCOS.