Infertility and assisted reproduction

Couple-first infertility evaluation

• Start evaluation after 12 months if woman is younger than 35, after 6 months if at least 35, and immediately with high-risk clues.
• Test both partners in parallel: semen, ovulation, ovarian reserve when relevant, tubal patency and uterine cavity.
• Main compartments: male, ovulatory, tubal/peritoneal, uterine/cervical and unexplained.

Male factor essentials

• Semen analysis comes first and should be repeated if abnormal or borderline.
• WHO 2021 lower limits include semen volume at least 1.4 mL, concentration 16 million/mL, total count 39 million, total motility 42 percent, progressive motility 30 percent, morphology 4 percent.
• High FSH suggests testicular failure; normal FSH with azoospermia suggests possible obstruction.
• Exogenous testosterone suppresses spermatogenesis.

Ovulation, reserve and age

• Regular 21-35-day cycles usually mean ovulation; progesterone is timed about 7 days before expected menses.
• Reserve tests include AMH, AFC and early FSH/E2; they predict stimulation response better than natural conception.
• Age is the strongest fertility predictor.

Tubes, unexplained infertility and ART

• HSG/HyCoSy shows tubal spill; proximal block may be spasm.
• Hydrosalpinx can reduce IVF success and may need treatment before IVF.
• IUI needs at least one patent tube; IVF bypasses tubes; ICSI helps severe male factor.
• OHSS risk is highest in high responders and PCOS.