Infertility is usually defined as the failure to conceive after 1 year of sexual intercourse without contraception.
It is divided into 2 categories:
- Primary: The woman has never conceived in spite of having unprotected sexual intercourse for at least 12 months
- Secondary: The woman has previously conceived but is subsequently unable to conceive for 12 months despite unprotected sexual intercourse.
Causes of infertility include the following:
- Tubal factor: There is bilateral occlusion of fallopian tubes as a result of PID.
- Male factor: The sperm ducts are damaged as a result of previous STIs leading to abnormalities of sperm function.
- Endocrine disorders affecting the woman.
- Tropical diseases in male and female, including leprosy, filariasis, schistosomiasis, or tuberculosis.
- Cervical mucus abnormalities.
- Congenital disorders.
Any couple desiring children who do not achieve a pregnancy within 1 year of adequate exposure should have a systematic evaluation of their reproductive function. Most patients will require a detailed work-up, thus patients should be referred to a gynaecologist after a good history and examination rule out immediately treatable causes. Since infertility results from female OR male
problems, both partners should be prepared to undergo evaluation.
Diagnosis depends on:
- History from couple and individually.
- Physical examination of both partners.
- Basal body temperature
- HSG for tubal patency
- Hormone assays where indicated
- Dye laparoscopy.
- Definitive treatment depends on the cause as per the investigations above and may include:
- Counselling on sexual technique and fertility awareness
- Ovulation induction: Clomiphene citrate 50mg OD for 5 days starting from day 2–5 of menstrual cycle
- Tubal surgery
- Vas surgery
- Assisted reproduction