Failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse (in absence of known reason) in a couple who have never had a child

Aetiology

Definitions

• Either primary (couple never conceived) or secondary (couple previously conceived, although pregnancy may not have been successful e.g. miscarriage, ectopic pregnancy)
• Infertility is classed as a disease as it causes considerable psychological distress

Factors which increase chance of conception

• Women under 30
• Previous pregnancy
• Less than 3 years trying to conceive
• Intercourse occurring around ovulation
• Woman's BMI 18.5-30 m/kg2
• Both partners non-smokers
• Caffeine intake of less than 2 cups a day
• No recreational drug use

Female infertility

Anovulatory infertility

• Infertility due to lack of ovulation
• Physiological
  • Before puberty, pregnancy, lactation, menopause
• Gynaecological conditions
  • Hypothalamic: anorexia/bulimia, excessive exercise, stress, Kallman's syndrome
  • Pituitary: hyperprolactinaemia, tumours, Sheehan syndrome
  • Ovarian: PCOS, premature ovarian failure
• Others
  • Systemic disorder e.g. chronic renal failure
  • Endocrine disorder e.g. testosterone secreting tumours, congenital adrenal hyperplasia, thyroid
  • Drugs e.g. depo-provera, explanon, OCP