Infertility: Infertility evaluation in fertile women: a model for assessing the efficacy of infertility testing

Abstract

A standard infertility evaluation consists of a semen analysis, hysterosalpingogram, post-coital test, endometrial biopsy and laparoscopy. Although these tests are well grounded in clinical experience, information on their ability to discriminate between fertile and infertile couples is limited. In this study, we performed standard infertility tests plus two others--sperm antibodies and cervical culture for Mycoplasma hominis and Ureaplasma urealyticum--on fertile and infertile couples. Women in the fertile group were selected from those who had delivered a child within the previous 2 years and who were scheduled for a laparoscopic tubal ligation. Women in the infertile group were selected from those presenting for an infertility evaluation (mean duration of infertility 4.2 years), and they were matched by age (+/- 3 years) and race with fertile subjects. Subjects were recruited from both private and clinic patients. A total of 64 couples (32 matched pairs) completed the evaluation. At least one 'abnormal' infertility test was found in 69% of fertile and 84% of infertile couples. With the exception of tubal damage and endometriosis, which as expected were more common in infertile couples, no significant differences between groups for remaining infertility factors could be demonstrated. Despite the small size of the current study, these results confirm the feasibility and importance of comparisons of the prevalence of infertility factors in fertile and infertile couples.

Sperm DNA damage measured by the alkaline Comet assay as an independent predictor of male infertility and in vitro fertilization success

“…A large proportion of couples undergoing IVF treatment have female causes and after standard infertility evaluations of semen analysis, and assessment of ovulation and tubal function (7), approximately 15% of couples still have unexplained infertility (8). In this study, to evaluate the effects of sperm DNA damage, couples with female factors or without detectable fertility problems from either partner (idiopathic infertility) were excluded and only couples diagnosed with male factor infertility by presenting abnormal semen parameters according to World Health Organization (WHO) criteria were included.…”

Potential Etiologies of Unexplained Infertility in Females

“…If endometriosis does so in vitro, it can be expected to have similar effects in vivo leading to impaired conception [5]. Studies have demonstrated that, even in mild cases of endometriosis, pregnancy outcomes may have been affected by subtle tubal abnormalities [55,56], thus reflecting microscopic endometriosis in the fallopian tubes, which can never be totally excluded, even by LPS [19][20]. Furthermore, data on patients undergoing LPS for infertility indicate that of those who have no macroscopic endometriosis at LPS, at least 6 % have microscopic lesions [57,58] and thus confirms how this diagnosis, especially in patients with infertility may be underestimated [59].…”

Role of Assisted Reproduction Techniques in the Management of Unexplained Male Infertility

“…Although estimates will vary, the percentage of couples with unexplained infertility is between 10-15 % [117]. Couples with unexplained infertility are affected by both decreased and delayed fecundity.…”