Infertility is the inability to get pregnant after 12 months of regular unprotected sex, or after 6 months if the woman is 35 or older. Causes are found in the female partner, the male partner or both, so both should be evaluated.
Key symptoms
- No pregnancy despite regular unprotected sex
- Irregular or absent periods
- Painful periods or pelvic pain
- History of pelvic infection, surgery or prior miscarriages
- Emotional stress and strain on the relationship
What you find on exam
- BMI and signs of excess androgen: acne, hirsutism
- Thyroid exam and check for galactorrhea
- Pelvic exam for masses or tenderness
- Male partner: testicular size and varicocele
Tests
- Ovulation check: cycle history or mid-luteal progesterone
- TSH, prolactin and ovarian reserve (AMH)
- Hysterosalpingogram for open tubes and the uterine cavity
- Semen analysis for the male partner
Treatment basics
- Lifestyle: healthy weight, no smoking, less alcohol, folic acid
- Ovulation induction with letrozole or clomiphene
- Intrauterine insemination
- In vitro fertilization for tubal, severe male factor or unexplained cases
- Counseling and referral to a fertility specialist
Red flags
- Positive pregnancy test with pain or bleeding (ectopic pregnancy)
- Abdominal swelling, rapid weight gain or breathlessness after treatment (ovarian hyperstimulation)
- Primary amenorrhea or signs of a pituitary tumor
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.