Infertility (Male and Female)

Last updated: Tuesday, 14, December, 2010
CausesAppropriate Tests

Male

Clinical assessment includes duration of infertility, scrotal and penile development, testicular volume, evidence of androgen deficiency.

Semen analysis including sperm antibodies.

Sperm function tests (eg, structural abnormalities, oocyte binding) are available in only a few specialised laboratories. FSH, LH, testosterone, prolactin; testicular biopsy is rarely indicated (special fixative required).

See Table 7 Reference intervals for testosterone and related androgens (serum)

Testicular failure

Hypogonadotrophic hypogonadism
 (hypothalamic/pituitary disorders)

See Pituitary/hypothalamic disorders

Gonadotrophin releasing hormone
  deficiency (Kallman syndrome)

See Pituitary/hypothalamic disorders

Panhypopituitarism 

See under Hypopituitarism

Prolactinoma

See Pituitary hormone excess

Haemochromatosis

Hypergonadotrophic hypogonadism
 (primary testicular disorders)

Chromosome abrnomalilties

Cytogenetics (non-oncology).

Klinefelter syndrome

Cryptorchidism

Bilateral anorchia

Noonan syndrome

Vanishing testis syndrome
Acquired testicular failure

  • Trauma - thermal/physical
  • Varicocoele
  • Cirrhosis
  • Renal failure
  • Cytotoxic drugs/irradiation
  • Viral orchitis
  • Myotonic dystrophy
  • Autoimmune

 

 

Usually eugonadotrophic.

 

History of mumps, or other viral infection, associated with orchitis.
See under Muscular dystrophy
Sperm antibodies.

Anatomical abnormalities eg

Hypospadias

Obstruction to vas deferens or epididymis, especially

Erectile dysfunction

Retrograde ejaculation

Autoimmune especially

Sperm antibodies

Post-vasectomy repair

Post-torsion

Female

Clinical assessment includes menstrual history and duration of infertility; consider the possibility of infertility in partner - see above. Endometrial biopsy, if indicated, to evaluate the response to endogenous hormones and to exclude infection and neoplastic lesions. See also Amenorrhoea

Tubal/uterine disease, especially

Anatomical abnormalities

Anovulation

The patient may present with amenorrhoea or oligomenorrhoea or may have a normal menstrual history, in which case anovulatory cycles may be occurring or the luteal phase may be inadequate. Serial LH and progesterone assays to detect the absence of an LH surge at ovulation or inappropriate luteal progesterone levels.