Chapter 170 Infertility
INTRODUCTION
Description: Infertility is the inability to conceive or bear a child despite more than 1 year of trying. Under ordinary circumstances, 80% to 90% of normal couples conceive during 1 year of attempting pregnancy. Infertility may be further subdivided into primary and secondary types based on the patient’s past reproductive history: patients who are infertile and nulligravid are in the primary infertility group and those who have become pregnant more than 1 year previously, regardless of the outcome of that pregnancy, are in the secondary infertility group. Slightly more than one half of patients experiencing infertility fall into the primary group.
Prevalence: Eight percent to eighteen percent of the American population; slightly higher for couples who have never conceived and slightly lower for couples who have conceived before. Roughly 6.1 million women in the United States.
Predominant Age: Reproductive. The prevalence of infertility increases with the age of the woman. Age-related infertility is becoming more common because about 20% of American women delay their attempts at pregnancy to after age 35.
ETIOLOGY AND PATHOGENESIS
Causes: Approximately 35% to 50% of infertility is due to a male factor such as azoospermia. Female factors, such as tubal disease (20% to 30%), ovulation disorders (10% to 15%), and cervical factors (5%), contribute to the roughly 50% to 60% of female causes. The remaining 10% to 20% of couples have no identifiable cause for their infertility (idiopathic). Couples experiencing primary infertility are more likely to have idiopathic or chromosomal causes than are couples who have conceived previously.
DIAGNOSTIC APPROACH
Differential Diagnosis
• Primary infertility—chromosomal abnormality (e.g., 45,XO [Turner’s syndrome], 46,XY gonadal dysgenesis [Swyer syndrome], 46,XX q5 X chromosome long-arm deletion)
Workup and Evaluation
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