Chapter 22 INFERTILITY
Infertility affects one couple in six and becomes more common as people age. Clinical evaluation of infertility is indicated if a pregnancy has not occurred after 1 year of regular unprotected intercourse. An infertility work-up should also be initiated in female patients who complain of infertility and have any of the following abnormalities: irregular menses or amenorrhea, bleeding between periods, dyspareunia, history of upper genital tract infection, history of a ruptured appendix or other abdominal surgery, or age older than 35 years.
In approximately 5% to 10% of infertile couples who proceed through a complete infertility evaluation, no cause is identified; these couples are said to have unexplained infertility. Infertility clinics may perform additional specialized testing, such as ultrasonography, testing for antisperm antibodies, and sperm function assays. Empirical treatment regimens have been designed to treat subtle disorders that may not be diagnosed.
