by Olaide Akande

Created on: July 09, 2009   Last Updated: July 11, 2009

Infertility is the inability of a couple to achieve conception despite having adequate unprotected sexual intercourse (at least three times a week) for one year. Estimates of the number of couples affected by infertility In America approach 5 million. Similar values have been obtained worldwide as well.

The definition above in itself makes a diagnosis of infertility, however further work-up is obviously needed in reaching a diagnosis of the cause of the infertility, which may be due to female factors, male factors or a combination of both. Identifying the source of a couple's infertility involves a history, physical exam, lab work, imaging studies and sometimes, surgery.

History and Physical Exam

Some factors in the history may be a pointer to the reason for infertility in a couple. Habits such as alcohol intake and smoking may have an effect on a couple's fertility. The temperature of the scrotal sac is a degree lower than that of the rest of the body. This is essential for optimal functioning of the testes. Conditions that may increase the scrotal temperature, such as wearing of tight underwear, hot baths, or presence of a varicocele (enlarged veins within the scrotum), need to be elucidated from the history and physical exam. The use of any medications or recreational drugs needs to be found out as these may also affect fertility.

Seminal Analysis

Abnormalities in sperm mobility, structure or numbers is a common cause of male infertility and this can easily be discovered by a simple laboratory test called seminal analysis. It is often the first line of investigation for males. The man provides a sample of his semen after 2 days of abstinence; this is commonly obtained by masturbation. The semen is then analyzed by viewing under a microscope to determine the sperm count; normal values being about 20 million per ml of the ejaculate. Presence of abnormal shapes and motility of the spermatozoa are also checked for.

Hormone Assays

Women with a hormonal basis for their infertility may have irregular menses, milky discharge from the breasts, be under extreme stress or be underweight or overweight. Some may however have none of these situations. Blood tests are done at specific intervals of the menstrual cycle to measure the levels of some of the key hormones involved in regulating the reproductive cycle. By correlating the levels with the time of the cycle, specific diagnoses can be established. Examples of some of the conditions that can be identified with

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