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- Title
Infertility: Testing and diagnosis for the community physician.
- Authors
Dunne, Caitlin
- Abstract
Infertility is a condition commonly encountered by family physicians in the community. Timely diagnosis and treatment of infertility can help to mitigate the clinical and emotional consequences for the patient and her partner. Investigations for infertility should be initiated after a year of trying without pregnancy, although a community physician would be advised to order testing before a year of trying in four common clinical situations: female age over 35 years, presence of oligomenorrhea, presence of risk factors for tubal disease, and suspicion of male factor infertility. Standard investigations include ovulation testing such as cycle tracking, use of ovulation predictor kits, basal body temperature charting, and serum progesterone measurement. Ovarian reserve testing should be undertaken to assess the monthly cohort of hormone- responsive (pre-antral and antral) follicles. The most common endocrine ovarian test involves measuring follicle-stimulating hormone levels on day 3 of the menstrual cycle. Additional ovarian reserve tests such as anti-Miillerian hormone assay and/or antral follicle count (done by ultrasound in a fertility clinic) can improve sensitivity, specificity, and convenience. Uterine-tubal evaluation may be undertaken with hysterosalpingography while hysteroscopy or sonohysterography can be used to further investigate the endometrial cavity as needed. Semen analysis is a fundamental part of the workup because the male factor accounts for approximately 35% of infertility. Infertility investigations should start after 6 months of trying for women over 35 years, and for women over 40 years investigations should be initiated immediately. Consultation with a gynecologist or fertility specialist is covered by provincial health insurance and should be considered for couples with abnormal test results and for couples who fail to conceive despite normal test results.
- Subjects
INFERTILITY; HUMAN reproduction; INFERTILITY treatment
- Publication
British Columbia Medical Journal, 2018, Vol 60, Issue 4, p203
- ISSN
0007-0556
- Publication type
Article