Infertility: Diagnosis and Treatment

Diagnosis

• The evaluation begins with a medical history and a physical examination.
  
• Blood testing and genetic testing may be useful in some cases.
  
• In men, a semen analysis is done to measure the sperm count. In some cases, further testing may be necessary, including ultrasound or biopsy of the testicles.
  
• In women, testing to assess sex hormone concentrations and the sufficiency of ovulation may be necessary. In some cases, further testing is needed, including X–rays, ultrasound, or hysteroscopy.

Treatment

• Lifestyle changes may improve the ability to achieve pregnancy. These include cessation of cigarette smoking, reduction of alcohol and caffeine intake, maintenance of a healthy body weight, and regular physical activity.
  
• Timed intercourse, in which couples identify the fertile period to increase the rate of pregnancy, may increase the success rate by 30 percent or more. The most fertile time in a women’s menstrual cycle is one to two days before ovulation.
  
• Medications (e.g., clomiphene, letrozole) can be effective when infertility is due to lack of ovulation. However, these medications significantly increase the risk for multiple gestations (twins, triplets, quadruplets, and quintuplets).  
  
• In vitro fertilization (IVF) has been used for more than two decades. In this procedure, several eggs are taken from the ovary, fertilized by sperm in a test tube, and then transferred into the uterus. IVF appears to be useful for many cases of infertility. However, further study is necessary to best define when IVF should be used.