infertility

(in″fĕr-til′ĭt-ē)

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[²in- + fertility]
Inability to achieve pregnancy during a year or more of unprotected intercourse.

INCIDENCE
The condition may be present in either or both partners and may be reversible. In the U.S., about 20% of all couples are infertile.

CAUSES
In women, infertility may be primary (in women who have never conceived) or secondary (after previous conceptions or pregnancies). Causes of primary infertility in women include ovulatory failure, anatomical anomalies of the uterus, Turner syndrome, and eating disorders. Common causes of secondary infertility in women include but are not limited to tubal scarring (as after sexually transmitted infections), endometriosis, cancers, and chemotherapy. In men, infertility usually is caused by failure to manufacture adequate amounts of sperm (due to exposure to environmental toxins, viruses, or bacteria; developmental or genetic diseases; varicoceles, or endocrine abnormalities).

DIAGNOSIS
When investigating infertility, both partners should be examined. A routine examination for the female includes a study of the vaginal secretions, a bimanual pelvic examination, visualization of the cervix, in some cases, a test for patency of the fallopian tubes, and a record of basal body temperature. A history of pelvic disease in the female is of great importance. The male should have the seminal fluid examined for the number, motility, viability, and normality of the spermatozoa, and occasionally other tests (as of testosterone levels).

TREATMENT
Treatment of infertility depends on the finding and correction of any or all causes of the condition. A high percentage of couples who are infertile during the first year in which they are trying to have a child will, without treatment, produce offspring.

PATIENT CARE
Concerns about fertility may have powerful emotional impacts on couples who would like to have children and raise a family. Health care professionals, including both primary care providers and fertility specialists, should explore with infertile couples their visions, goals and desires for family life.

The physiological investigation begins with comprehensive histories from both partners, assessment of their usual timing of intercourse, and thorough physical examinations. The initial test for men is semen analysis to assess sperm morphology, motility, and number. This should be done after 2 to 3 days of sexual abstinence. At least two to three ejaculates, obtained at no less than 1-week intervals, should be examined because of the variability in sperm counts. Female assessment usually begins with evaluation of ovulation by a basal body temperature graph or home ovulation prediction kit. Additional special assessments of the woman may be ordered to evaluate ovarian, tubal, uterine, and cervical factors.

The specific problems that testing identifies may be managed by either pharmacological or surgically assisted reproduction techniques. Pregnancy after a diagnosis of infertility is now a common event. Health care professionals should help infertile couples to understand the anxieties that may accompany pregnancy, the impact infertility has had on their sense of confidence and mastery of parental roles, and help them transition to the new challenges they may face as a result of the use of reproductive technologies, including pre-term birth, cesarean delivery, postpartum depression or insecurity, and multiple pregnancies. The goal of these interventions is to make the experience of pregnancy joyful, and the relationship between new parents and their children happy and successful.
SEE: embryo transfer; SEE: in vitro fertilization; SEE: gamete intrafallopian transfer; SEE: transcervical balloon tuboplasty

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