Infertility is defined as the inability to achieve conception (pregnancy) after engaging in regular sexual intercourse without using contraception for a duration of 12 months. This period allows for a reasonable amount of time for conception to occur naturally.

In couples who are trying to conceive naturally, approximately 50% of them achieve pregnancy after trying for about three months. However, the chances of conception increase with time, and by the end of 12 months, about 92% of couples will have successfully conceived.

Types of Infertility

  • Primary Infertility: This refers to cases where a couple has never experienced a successful conception in the past.
  • Secondary Infertility: In these cases, at least one prior pregnancy or conception has been documented for the couple. However, despite having conceived before, they are now struggling to achieve another pregnancy.
  • Sterility: In these cases, the cause of infertility has been identified and is deemed irreversible. In other words, the underlying reasons for the inability to conceive have been established, and there is no possibility for natural conception to occur.

Frequent Underlying Etiology of Infertility

  1. Female Factor: Approximately 40% of infertility cases are attributed to factors related to the female reproductive system. These factors could include issues with ovulation, hormonal imbalances, fallopian tube blockages, uterine abnormalities, or other conditions that affect the ability to conceive.
  2. Male Factor: Similarly, around 40% of infertility cases can be attributed to factors related to the male reproductive system. These factors might involve sperm-related issues such as low sperm count, poor sperm motility (movement), or abnormal sperm morphology (shape).
  3. Undetermined Etiology: In a subset of cases (around 10-20%), despite medical evaluation, no clear cause for infertility can be identified. In other words, the underlying reason for the inability to conceive remains unknown even after diagnostic tests and examinations have been conducted.

Infertility Evaluation

  1. History and Physical Examination: The evaluation of infertility begins with a thorough medical history and physical examination. This step aims to gather information about the individuals’ medical background, lifestyle, and potential factors that might contribute to infertility. The physical examination helps identify any visible abnormalities or signs that could provide insights into the underlying causes.
  2. Sexual History: Obtaining a detailed sexual history is also crucial in understanding a couple’s sexual habits and practices, including information about the frequency and timing of sexual intercourse, as well as any factors that might affect fertility, such as the use of lubricants that could potentially impact sperm viability.
  3. Menstrual History: A complete menstrual history for the female partner is also important, and will involve tracking the regularity and characteristics of menstrual cycles. Irregular menstrual cycles or abnormalities in menstruation could indicate hormonal imbalances or other issues affecting fertility.

Questions may be used to assess menstrual patterns:

Menstrual cycle duration:

  • How long is your menstrual cycle on average?
  • Is it typically within the range of 21 to 35 days, or does it fall outside this range?

Duration of menstrual bleeding:

  • How many days does your menstrual bleeding usually last?
  • Does it typically last between 2 to 7 days?

Presence of associated symptoms or pain:

  • Do you experience any symptoms or pain during your menstrual period?
  • If yes, when do these symptoms or pain occur?

Timing of symptoms/pain:

  • Are the symptoms or pain experienced before, during, or after your period?

How pain is described:

  • What are these symptoms or pain commonly referred to as?

Occurrence of spotting:

  • Do you experience any spotting between your menstrual periods?
  • When does this spotting typically occur in relation to your menstrual cycle?
  • Do you think there is any potential significance or reasons for the spotting?
  • Are there any specific factors or medical conditions that may be causing the spotting episodes?

Answering these questions can help gauge the characteristics of a menstrual cycle and provide insights into whether it falls within the typical or atypical range. If any concerns or irregularities are identified, it’s advisable to consult with a healthcare professional for further evaluation and guidance.


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Human Reproduction: A Clinical Approach Copyright © 2023 by Dr. Hala Bastawros, M.D is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.