Materiały źródłowe

• #1 Diagnosis and Management of Infertility

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9302705/

  Infertility is defined as the failure to achieve pregnancy after 12 months of regular unprotected sexual intercourse. Approximately 85% of infertile couples have an identifiable cause. The most common causes of infertility are ovulatory dysfunction, male factor infertility, and tubal disease. The remaining 15% of infertile couples have unexplained infertility. […] Infertility is caused by identifiable abnormalities in normal physiology or underlying disease in 85% of infertile couples. The most common causes of infertility are ovulatory dysfunction, male factor infertility, and tubal disease. The remaining 15% of infertile couples have unexplained infertility. […] Women who have not achieved pregnancy after 12 months of unprotected intercourse or donor insemination should be offered an infertility evaluation. Earlier evaluation is recommended for women older than 35 years who have failed to conceive for 6 months; for women older than 40 years, immediate evaluation is warranted.

• #1 Female infertility – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/female-infertility/diagnosis-treatment/drc-20354313

  If you’ve been unable to conceive within a reasonable period of time, seek help from your doctor for evaluation and treatment of infertility. You and your partner should be evaluated. Your doctor will take a detailed medical history and conduct a physical exam. […] Fertility tests might include: […] Hysterosalpingography. During hysterosalpingography (his-tur-o-sal-ping-GOG-ruh-fee), X-ray contrast is injected into your uterus and an X-ray is taken to check for problems inside the uterus. The test also shows whether the fluid passes out of the uterus and spills out of your fallopian tubes. If any problems are found, you’ll likely need further evaluation. […] Ovarian reserve testing. This testing helps determine the quality and quantity of eggs available for ovulation. Women at risk of a depleted egg supply including women older than 35 might have this series of blood and imaging tests.

• #1 Infertility Diagnosis – Austin Fertility Clinic – Diagnosing Infertility

  https://txfertility.com/infertility-diagnosis/

  Fertility blood tests. An important aspect of infertility evaluations is blood work. This testing allows us to assess a hopeful mother’s ovarian reserve and other hormone levels. These tests may include anti-Mullerian hormone (AMH), estradiol, prolactin, follicle-stimulating hormone (FSH), and thyroid-stimulating hormone (TSH). For hopeful fathers who have sperm issues, a blood test may be recommended to measure levels of testosterone and other hormones. […] Preconception genetic testing. Genetic screening is another tool that helps us reach the right infertility diagnosis. This screening helps us determine whether the hopeful parents have inheritable genetic conditions. If both hopeful parents are carriers of the same disease, we recommend preimplantation genetic diagnosis (PGD) with IVF to ensure that we only transfer healthy embryos.

• #1 Infertility Evaluation and Diagnosis – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/obgyn/infertility-reproductive-surgery/infertility-services/evaluation-and-diagnosis

  The goal of the initial infertility evaluation is to determine the likely cause of infertility, and to determine the best approach to infertility treatment. Your doctor will take a careful history and order various tests. […] A complete evaluation and diagnosis should include testing of both male and female partners. […] Most patients are very anxious to get started on their evaluations and treatment. […] At the beginning of the evaluation, the male partner should have a semen analysis. […] There are several baseline tests that are used to evaluate the cause of female infertility. […] This is done by testing the blood for FSH, E2, and AMH on day three of the menstrual cycle. […] Serum progesterone level can be measured in the second half of the cycle (day 20-22 in a 28-day cycle).

• #1 Fertility Testing & Diagnosis for Women | Women & Infants

  https://fertility.womenandinfants.org/treatment/female-fertility-tests

  The first appointment will provide information for the doctor to determine if further testing should be conducted. […] The pelvic ultrasound can diagnose such problems as an abnormally shaped uterus or cysts in the ovaries. […] Blood tests are done at different times during a womans menstrual cycle to measure hormone levels in the blood. […] An evaluation for follicle-stimulating hormone (FSH) levels drawn on cycle day three (three days after a womans period starts) is a common test for women. […] Testing for ovarian reserve assesses the potential number of eggs a woman has in her ovaries. […] Laparoscopy is a minimally invasive surgery in which the doctor inserts a camera and small surgical instruments into the abdominal cavity through a small incision in the belly button. […] Sonohysterogram uses a saline solution to fill the uterine cavity and a transvaginal ultrasound to create a clear image of the uterus.

• #1 Diagnosis and Management of Infertility

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9302705/

  Ovulatory disorders account for approximately 25% of infertility diagnoses; 70% of women with anovulation have polycystic ovary syndrome. […] For individuals presenting with anovulation, ovulation induction with timed intercourse is often the appropriate initial treatment choice. […] For couples with unexplained infertility, the American Society for Reproductive Medicine recommends an initial 3 to 4 cycles of ovarian stimulation with intrauterine insemination, an approach that can also be used for women with endometriosis or partners with mild male factor infertility. IVF should be considered if these approaches do not result in pregnancy. […] Immediate IVF may be considered as a first-line treatment strategy in women older than 38 to 40 years. IVF is also indicated in cases of severe male factor infertility or untreated bilateral tubal factor. […] Accurate diagnosis and effective therapy along with shared decision-making can facilitate achievement of fertility goals in many couples treated for infertility.

• #1 Evaluating Infertility | ACOG

  https://www.acog.org/womens-health/faqs/evaluating-infertility

  Laboratory tests may include blood and urine tests. A urine test can tell when and if you ovulate. Blood tests can measure: Progesterone levels (to see if you have ovulated), Thyroid function (problems with the thyroid may cause infertility), Levels of the hormone prolactin (high levels can disrupt ovulation), Ovarian reserve (egg supply). […] Different imaging tests and procedures are used to look at the uterus, ovaries, and fallopian tubes to find problems. Some procedures also are used to treat certain problems if they are found. […] An infertility evaluation can be finished within a few menstrual cycles in most cases. […] Some insurance companies may cover the cost of an infertility evaluation. It is a good idea to call your insurance company to find out before you start your evaluation.

• #1 Diagnostic Testing for Infertility patient education fact sheet | ReproductiveFacts.org

  https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/diagnostic-testing-for-infertility/

  Ovarian reserve testing is more important when the patient is 1) over age 35 years; 2) has a family history of early menopause; 3) has a single ovary; 4) has a history of previous ovarian surgery, chemotherapy, or pelvic radiation therapy; 5) has endometriosis or unexplained infertility; or 6) has shown poor response to gonadotropin ovarian stimulation in prior treatment cycles. […] Thyroid-stimulating hormone (TSH) and prolactin levels are useful in identifying thyroid disorders and hyperprolactinemia, which may cause problems with fertility, menstrual irregularities, and repeated miscarriages. […] Over-the-counter ovulation predictor kits detect the presence of LH in urine and can detect a rise in this hormone that occurs one to two days before ovulation. […] An evaluation of a woman for infertility is appropriate for women who have not become pregnant after having 12 months of regular, unprotected intercourse. […] If you haven’t been able to get pregnant after trying for 6 months, some tests can be done to help find the reason.

• #1 Female Infertility Tests and Diagnosis | Get Answers Today

  https://www.infertilityalabama.com/list-of-services/female-diagnostic-infertility-tests-procedures/

  This is an X-ray that allows us to evaluate the fallopian tubes and uterine cavity. […] This ultrasound assesses the shape of the uterus and can detect abnormalities, including fibroids and uterine polyps. […] This procedure allows us to evaluate the uterine cavity and lining and to detect polyps and fibroids. […] Follicular Dynamic Ultrasounds are used to track follicle growth and to identify and measure the size of the dominant follicle or follicles. It also helps evaluate the timing of ovulation.

• #1 Evaluation and Treatment of Infertility | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0301/p308.html

  Infertility is defined as the inability to become pregnant after 12 months of regular, unprotected intercourse. […] It is important for primary care physicians to be familiar with the workup and prognosis for infertile couples. […] Evaluation of male infertility starts with a history and physical examination focusing on previous fertility, pelvic or inguinal surgeries, systemic diseases, and exposures. The laboratory evaluation begins with a semen analysis. […] The etiology of female infertility can be broken down into ovulation disorders, uterine abnormalities, tubal obstruction, and peritoneal factors. […] Women with regular menstrual cycles are likely to be ovulating and should be offered serum progesterone testing at day 21 to confirm ovulation. […] Women with no clear risk of tubal obstruction should be offered hysterosalpingography to screen for tubal occlusion and structural uterine abnormalities.

• #1 Female infertility – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/female-infertility/diagnosis-treatment/drc-20354313

  Other hormone testing. Other hormone tests check levels of ovulatory hormones as well as thyroid and pituitary hormones that control reproductive processes. […] Imaging tests. A pelvic ultrasound looks for uterine or fallopian tube disease. Sometimes a sonohysterogram, also called a saline infusion sonogram, or a hysteroscopy is used to see details inside the uterus that can’t be seen on a regular ultrasound. […] Genetic testing helps determine whether there any changes to your genes that may be causing infertility.

• #1 Infertility – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infertility/diagnosis-treatment/drc-20354322

  Testicular biopsy. This procedure removes a small amount of testicle tissue so a lab can check it under a microscope. […] Imaging. In some cases, your health care team may recommend tests that make pictures of the inside of your body. […] Tests for female infertility try to find problems with any of those steps. […] Infertility tests may include: Ovulation testing. A blood test measures hormone levels to find out whether you’re ovulating. […] Hysterosalpingography. Hysterosalpingography checks on the condition of the uterus and fallopian tubes. […] Ovarian reserve testing. This helps your care team find out how many eggs you have for ovulation. […] Rarely, testing may include: Hysteroscopy. Depending on your symptoms, your health care team may use a hysteroscopy to look for a disease of the uterus. […] Laparoscopy. Laparoscopy involves a small cut beneath the navel. […] Not everyone needs to have all, or even many, of these tests before the cause of infertility is found.

• #1 Infertility: Types, Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/16083-infertility

  Infertility affects both men and and women. Infertility is very common. In the United States, 1 in 5 women between 15 and 49 years old struggle with primary infertility and about 1 in 20 women struggle with secondary infertility. Approximately 48 million couples live with infertility around the world. […] Ovulation disorders are the most common cause of infertility in women. […] The most common cause of male infertility involves problems with the shape, movement (motility) or amount (low sperm count) of sperm. […] Diagnosing infertility in men typically involves making sure they ejaculate healthy sperm. Most fertility tests look for problems with sperm. […] Treatment for infertility depends mostly on the cause and your goals. […] In 85% to 90% of cases, lifestyle modification, medication, ART or surgery can treat infertility and allow a woman to conceive.

• #1 Infertility – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/infertility/diagnosis-treatment/drc-20354322

  Before infertility testing, your health care team or clinic works to understand your sexual habits. […] Infertility testing can involve uncomfortable procedures. It can be expensive too. And some medical plans may not cover the cost of fertility treatment. Also, there’s no guarantee that you’ll get pregnant even after all the testing and counseling. […] Tests for male infertility try to find out whether there are treatable problems with any of these steps. […] Specific infertility tests may include: Semen analysis. Your health care team may ask for one or more samples of your semen. […] Hormone testing. You may get a blood test to check your level of testosterone and other male hormones. […] Genetic testing. This may be done to find out whether a genetic defect is the cause of infertility.

• #1 Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/male-infertility

  Clinicians may manage male infertility with assisted reproductive technology. […] Clinicians may advise an infertile couple with a low total motile sperm count on repeated semen analyses that intrauterine insemination success rates may be reduced, and treatment with assisted reproductive technology (in vitro fertilization/intracytoplasmic sperm injection) may be considered. […] In a patient presenting with hypogonadotropic hypogonadism, clinicians should evaluate the patient to determine the etiology of the disorder and treat based on diagnosis. […] Clinicians may use aromatase inhibitors, human chorionic gonadotropin, selective estrogen receptor modulators, or a combination thereof for infertile males with low serum testosterone. […] For the male interested in current or future fertility, clinicians should not prescribe exogenous testosterone therapy.

• #1 Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I (2020) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-auaasrm-guideline-part-i-2020/

  Diagnostic testicular biopsy should not routinely be performed to differentiate between obstructive azoospermia and non-obstructive azoospermia (NOA). (Expert Opinion) SA and a male reproductive history should be obtained for all couples interested in fertility. Abnormalities in any one or more semen parameters can compromise a man’s ability to naturally impregnate his female partner except in cases of azoospermia, some types of teratozoospermia (e.g., complete globozoospermia), necrozoospermia, or complete asthenozoospermia. […] With the exception of the aforementioned anomalies (which clearly cause infertility), none of the individual sperm parameters (e.g., concentration, morphology, motility) are highly predictive of fertility or diagnostic of infertility. The odds ratio for infertility increases as the number of abnormal parameters increases. Clinicians managing results from a SA should counsel patients that multiple significant abnormalities in semen parameters increase their RR for infertility.

• #1 Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I (2020) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-auaasrm-guideline-part-i-2020/

  The SA is an important component in the initial clinical evaluation of the male and his reproductive health. Semen parameter values falling above or below the lower limit do not by themselves predict either fertility or infertility. In the interpretation of the SA, the clinician should remember that semen parameters are highly variable biological measures and may vary substantially from ejaculate to ejaculate. Therefore, at least two SAs, ideally obtained at least one month apart, are important to obtain, especially if the first SA has abnormal parameters. […] Evaluation and treatment of the male can improve SA and fertility outcomes allowing some couples to conceive naturally and potentially lower treatment costs. In addition to treatment benefits, 1-6% of men evaluated for infertility have significant undiagnosed medical pathology including malignancies even when they have so-called normal SAs. Just as all infertile women are treated by those with specialized gynecologic training and expertise, all infertile men be evaluated by specialists in male reproduction.

• #1 Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/male-infertility

  Clinicians should initially evaluate azoospermic males with physical exam, semen volume, semen pH, and serum follicle-stimulating hormone levels to differentiate genital tract obstruction from impaired sperm production. […] Clinicians should recommend karyotype testing for males with primary infertility and azoospermia or sperm concentration 5 million sperm/mL when accompanied by elevated follicle-stimulating hormone, testicular atrophy, or a diagnosis of impaired sperm production. […] Clinicians should recommend Y-chromosome microdeletion analysis for males with primary infertility and azoospermia or sperm concentration 1 million sperm/mL when accompanied by elevated follicle-stimulating hormone, testicular atrophy, or a diagnosis of impaired sperm production. […] Clinicians should recommend Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) mutation carrier testing (including assessment of the 5T allele) in males with vasal agenesis or idiopathic obstructive azoospermia.

• #1 Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I (2020) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-auaasrm-guideline-part-i-2020/

  Increased levels of round cells in the semen may result from a spermatogenic problem where spermatocytes and/or round spermatids are present in the ejaculate or from the presence of elevated levels of white blood cells in the semen (pyospermia). Special stains are required to differentiate germ cells and somatic cells. White blood cells in the semen may result from infection or inflammation in the proximal or distal male genital tract. […] Routine semen cultures have not been prospectively demonstrated to benefit infertile couples, so many male reproductive experts do not routinely screen for infection unless pyospermia is present. The clinician should discuss the importance of paternal structural autosomal defects in the evaluation of the couple with RPL and the need for the male partner to have a karyotype analysis.

• #1 Diagnosing Male Infertility | NYU Langone Health

  https://nyulangone.org/conditions/male-infertility/diagnosis

  A total absence of sperm is the cause of infertility in about 10 to 15 percent of infertile men. This is called azoospermia, and it can be caused by a genetic irregularity, hormone imbalance, or blockage in the tubes that carry sperm to the urethra. […] Doctors can diagnose varicocele by performing a physical examination. Your doctor may recommend an ultrasound for further evaluation of the size of the varicocele. […] To determine the cause of infertility and choose the treatment or treatments that best suit your needs, your NYU Langone urologist asks about your medical history and performs a physical examination. Sometimes, he or she also requests that certain tests be performed. […] NYU Langone urologists may test a mans semen to determine causes of infertility. Doctors examine semen volume, as well as the number of sperm, their shape, and their motility, or movement.

• #1 Diagnosis and Treatment of Unexplained Infertility

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2505167/

  The role of laparoscopy in the investigation of infertility has changed over the past decade. […] The role of laparoscopy should be performed in women with unexplained infertility or signs and symptoms of endometriosis or in whom reversible adhesive tubal disease is suspected. […] A diagnosis of unexplained infertility is made after the above-recommended testing fails to reveal any abnormality. […] The principal treatments for unexplained infertility include expectant observation with timed intercourse and lifestyle changes, clomiphene citrate and intrauterine insemination (IUI), controlled ovarian hyperstimulation (COH) with IUI, and IVF. […] The most expensive, but also most successful treatment of unexplained infertility consists of the spectrum of assisted reproductive technology including IVF, with or without ICSI.

• #1 Diagnosis and Treatment of Unexplained Infertility

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2505167/

  Over the past decade, significant advances have occurred in the diagnosis and treatment of reproductive disorders. […] In this review, we discuss the routine testing performed to diagnose unexplained infertility. […] Approximately 15% to 30% of couples will be diagnosed with unexplained infertility after their diagnostic workup. […] The infertility evaluation is typically initiated after 1 year of trying to conceive, but in couples with advanced female age ( 35 years), most practitioners initiate diagnostic evaluation after an inability to conceive for 6 months. […] When the results of a standard infertility evaluation are normal, practitioners assign a diagnosis of unexplained infertility. […] Although estimates vary, the likelihood that all such test results for an infertile couple are normal (ie, that the couple has unexplained infertility) is approximately 15% to 30%.

• #1 Unexplained Infertility: Tests, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/23187-unexplained-infertility

  According to one source, in 10% of couples trying to conceive, fertility tests are normal and there’s no detectable cause for infertility. But another source says unexplained infertility cases are as high as 30%. […] Yes, it’s possible to get pregnant if you’re diagnosed with unexplained infertility. A study from the National Institute of Health (NIH) found that 92% of couples with unexplained infertility who had fertility treatments ultimately had a child. A diagnosis of unexplained infertility doesn’t mean you have to give up your dreams of a baby. […] There isn’t one fertility test that can diagnose all irregularities that cause infertility. And testing methods aren’t 100% accurate (for example, they may not detect mild abnormalities). The American Society of Reproductive Medicine (ASRM) says fertility testing should include: A complete medical and sexual history, a physical exam, blood tests to look at hormone levels, assessment of reproductive organs such as your ovaries, fallopian tubes and uterus.

• #1 Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/male-infertility

  Clinicians should discuss the effects of gonadotoxic therapies and other cancer treatments on sperm production with patients prior to commencement of therapy. […] Clinicians should encourage males to bank sperm, preferably multiple specimens when possible, prior to commencement of gonadotoxic therapy or other cancer treatment that may affect fertility in males. […] Clinicians should inform patients undergoing chemotherapy and/or radiation therapy to avoid initiating a pregnancy for a period of at least 12 months after completion of treatment. […] Clinicians should inform patients that a semen analysis should be performed at least 12 months (and preferably 24 months) after completion of gonadotoxic therapies. […] Clinicians should inform males seeking paternity who are persistently azoospermic after gonadotoxic therapies that microdissection testicular sperm extraction is a treatment option. […] Newer research techniques, such as next generation sequencing (whole exome and whole genome sequencing) and -omic technologies have been applied to better identify underlying defects that may explain infertility in males.

• #1 Infertility Diagnosis – Austin Fertility Clinic – Diagnosing Infertility

  https://txfertility.com/infertility-diagnosis/

  We pride ourselves on offering state-of-the-art, customized care for hopeful parents, and we are here to answer any questions about an infertility diagnosis. […] If you are experiencing trouble conceiving, you should reach out about getting an infertility diagnosis. We encourage you to reach out to our compassionate staff who will help you set up a consultation with a fertility specialist at our Austin fertility clinic. This consult will help you gain a comprehensive understanding of how we can help you develop a healthy pregnancy. […] Contact us to learn more about an infertility diagnosis. […] Diagnosis […] Infertility Diagnosis […] Fertility Blood Tests […] Preconception Genetic Testing […] Female Fertility Evaluation […] Ovarian Reserve Testing […] AMH Testing for Ovarian Reserve […] Ultrasound Examination […] Hysterosalpingogram (HSG) […] Sonohysterogram […] Endometrial Receptivity Testing […] Surgical Evaluation of Infertility […] Recurrent Pregnancy Loss Testing […] Male Infertility Evaluation […] Advanced Male Fertility Testing […] Semen Analysis […] Semen Analysis Results […] Schedule a Semen Analysis […] Semen Collection Instructions […] Fertility Treatments […] Contact Us

• #1 Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/male-infertility

  For males who harbor a CFTR mutation or have absence of the vas deferens (unilateral or bilateral), clinicians should recommend genetic evaluation of the female partner. […] Clinicians should not recommend sperm DNA fragmentation analysis in the initial evaluation of the infertile couple. […] In patients with pyospermia, clinicians should evaluate the patient for the presence of infection. […] Clinicians should not perform antisperm antibody (ASA) testing in the initial evaluation of male infertility. […] For couples with recurrent pregnancy loss, clinicians should evaluate the male partner with karyotype and sperm DNA fragmentation. […] Clinicians should not routinely perform diagnostic testicular biopsy to differentiate between obstructive azoospermia and non-obstructive azoospermia.

• #1 Infertility in women – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/498

  Infertility in women is commonly caused by ovulatory dysfunction, tubal or other anatomical disorders, endometriosis, or unexplained infertility. […] In some cases, the diagnosis is unexplained if the definition of infertility is met but all investigations are normal. […] Diagnostic investigations include semen analysis, luteal-phase progesterone, urinary luteinising hormone (LH), transvaginal ultrasound scan, chlamydia antibody testing, hysterosalpingogram, hysterosalpingo-contrast sonography (HyCosY), basal follicle-stimulating hormone (FSH), saline infusion sonogram, antral follicle count, and serum anti-Mullerian hormone (AMH). […] Investigations to consider include serum LH, serum oestradiol, free serum testosterone, serum TSH, coeliac disease testing, serum prolactin, 3-dimensional ultrasonography, pelvic MRI, laparoscopy and hysteroscopy, and karyotyping.

• #1 Diagnosis and Treatment of Unexplained Infertility

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2505167/

  Couples should undergo a semen analysis, ovulation testing, assessment of ovarian reserve, and imaging to assess for tubal and uterine factors before a diagnosis of unexplained infertility is made. […] The optimal treatment strategy needs to be based on individual patient characteristics such as age, treatment efficacy, side-effect profile such as multiple pregnancy, and cost considerations.

• #1 Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I (2020) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-auaasrm-guideline-part-i-2020/

  For initial infertility evaluation, both male and female partners should undergo concurrent assessment. (Expert Opinion) Initial evaluation of the male for fertility should include a reproductive history. (Clinical Principle) Initial evaluation of the male should also include one or more semen analyses (SAs). (Strong Recommendation; Evidence Level: Grade B) Men with one or more abnormal semen parameters or presumed male infertility should be evaluated by a male reproductive expert for complete history and physical examination as well as other directed tests when indicated. (Expert Opinion) […] Couple infertility may be due to male factors, female factors or a combination of male and female factors therefore parallel evaluation of both partners is always required. To interpret male infertility studies in isolation from female factors is not appropriate for these couples. Maternal age is the strongest predictor of fertility outcome for couples. A male in an infertile couple should have an initial SA and male reproductive history evaluation. The reproductive history assessment provides important information about functional sexual, lifestyle and medical history including medications that can contribute to reduced fertility or sterility.

• #1 Diagnostic Testing for Infertility patient education fact sheet | ReproductiveFacts.org

  https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/diagnostic-testing-for-infertility/

  Fertility testing is typically recommended for heterosexual couples who have not become pregnant after 12 months of trying to conceive. […] Any evaluation for infertility should be done in a focused and cost-effective way to find all relevant factors and should include both partners. […] The semen analysis is an essential part of the infertility evaluation. A semen analysis should provide information about the number, movement, and shape of the sperm. […] This is an X-ray or ultrasound procedure to see if the fallopian tubes are open and to if the shape of the uterine cavity is normal. […] An ultrasound probe placed in the vagina allows the clinician to check the uterus and ovaries for abnormalities such as fibroids and ovarian cysts. […] The best indicator of egg quality is the age of the ovaries.

• #2 Infertility: Types, Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/16083-infertility

  Infertility is a condition where you cant get pregnant after one year of trying to conceive. […] If youre younger than 35, your healthcare provider may diagnose infertility after one year (12 months) of trying to conceive. Trying to conceive is defined as having regular, unprotected sex. If youre 35 or older, your provider may diagnose infertility after six months of regular, unprotected sex. […] Infertility is more common than you might think. Fortunately, there are many treatment options available for women who wish to begin or expand their family. […] The main sign of infertility is being unable to get pregnant after six months or one year of regular, unprotected sex. […] There are many causes of infertility, and sometimes, there isnt a simple answer as to why youre not getting pregnant. Only a healthcare provider can determine the cause and find the best treatment for you.

• #2 Unexplained Infertility: Tests, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/23187-unexplained-infertility

  According to one source, in 10% of couples trying to conceive, fertility tests are normal and there’s no detectable cause for infertility. But another source says unexplained infertility cases are as high as 30%. […] Yes, it’s possible to get pregnant if you’re diagnosed with unexplained infertility. A study from the National Institute of Health (NIH) found that 92% of couples with unexplained infertility who had fertility treatments ultimately had a child. A diagnosis of unexplained infertility doesn’t mean you have to give up your dreams of a baby. […] There isn’t one fertility test that can diagnose all irregularities that cause infertility. And testing methods aren’t 100% accurate (for example, they may not detect mild abnormalities). The American Society of Reproductive Medicine (ASRM) says fertility testing should include: A complete medical and sexual history, a physical exam, blood tests to look at hormone levels, assessment of reproductive organs such as your ovaries, fallopian tubes and uterus.

• #2 Infertility: Types, Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/16083-infertility

  Infertility affects both men and and women. Infertility is very common. In the United States, 1 in 5 women between 15 and 49 years old struggle with primary infertility and about 1 in 20 women struggle with secondary infertility. Approximately 48 million couples live with infertility around the world. […] Ovulation disorders are the most common cause of infertility in women. […] The most common cause of male infertility involves problems with the shape, movement (motility) or amount (low sperm count) of sperm. […] Diagnosing infertility in men typically involves making sure they ejaculate healthy sperm. Most fertility tests look for problems with sperm. […] Treatment for infertility depends mostly on the cause and your goals. […] In 85% to 90% of cases, lifestyle modification, medication, ART or surgery can treat infertility and allow a woman to conceive.

• #2 Quest Women’s Health

  https://www.questwomenshealth.com/pregnancy-and-fertility/considering-pregnancy/male-and-female-fertility

  ReproSource is a pioneer in establishing the clinical utility of AMH for fertility specialists and has calibrated the assay results to the number of eggs retrieved through ovarian hyperstimulation. […] ReproSource also offers unique male fertility testing that accurately identifies the genetic factors that impact male fertility. […] The ReproSource Y-Chromosome MicroDeletions (YCMD3.0) test was developed in collaboration with world renowned scientists in the field of Y chromosome research. […] ReproSource also provides chromosome karyotyping services.

• #2 Evaluation and Treatment of Infertility | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0301/p308.html

  Infertility is defined as the inability to become pregnant after 12 months of regular, unprotected intercourse. […] It is important for primary care physicians to be familiar with the workup and prognosis for infertile couples. […] Evaluation of male infertility starts with a history and physical examination focusing on previous fertility, pelvic or inguinal surgeries, systemic diseases, and exposures. The laboratory evaluation begins with a semen analysis. […] The etiology of female infertility can be broken down into ovulation disorders, uterine abnormalities, tubal obstruction, and peritoneal factors. […] Women with regular menstrual cycles are likely to be ovulating and should be offered serum progesterone testing at day 21 to confirm ovulation. […] Women with no clear risk of tubal obstruction should be offered hysterosalpingography to screen for tubal occlusion and structural uterine abnormalities.

• #2 Female infertility – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/female-infertility/diagnosis-treatment/drc-20354313

  Other hormone testing. Other hormone tests check levels of ovulatory hormones as well as thyroid and pituitary hormones that control reproductive processes. […] Imaging tests. A pelvic ultrasound looks for uterine or fallopian tube disease. Sometimes a sonohysterogram, also called a saline infusion sonogram, or a hysteroscopy is used to see details inside the uterus that can’t be seen on a regular ultrasound. […] Genetic testing helps determine whether there any changes to your genes that may be causing infertility.

• #2 Evaluation and Treatment of Infertility | AAFP

  https://www.aafp.org/pubs/afp/issues/2015/0301/p308.html

  Treatment of tubal obstruction generally requires referral for subspecialty care. […] Couples who have no identified cause of infertility should be counseled on timing of intercourse for the most fertile period (i.e., the six days preceding ovulation). […] Patients should be counseled that 50% of couples who have not conceived in the first year of trying will conceive in the second year. […] Intrauterine insemination and ovulation induction do not result in increased pregnancy rates in women with unexplained infertility.

• #2 Evaluating Infertility | ACOG

  https://www.acog.org/womens-health/faqs/evaluating-infertility

  Laboratory tests may include blood and urine tests. A urine test can tell when and if you ovulate. Blood tests can measure: Progesterone levels (to see if you have ovulated), Thyroid function (problems with the thyroid may cause infertility), Levels of the hormone prolactin (high levels can disrupt ovulation), Ovarian reserve (egg supply). […] Different imaging tests and procedures are used to look at the uterus, ovaries, and fallopian tubes to find problems. Some procedures also are used to treat certain problems if they are found. […] An infertility evaluation can be finished within a few menstrual cycles in most cases. […] Some insurance companies may cover the cost of an infertility evaluation. It is a good idea to call your insurance company to find out before you start your evaluation.

• #2 Infertility Diagnosis – Austin Fertility Clinic – Diagnosing Infertility

  https://txfertility.com/infertility-diagnosis/

  Fertility blood tests. An important aspect of infertility evaluations is blood work. This testing allows us to assess a hopeful mother’s ovarian reserve and other hormone levels. These tests may include anti-Mullerian hormone (AMH), estradiol, prolactin, follicle-stimulating hormone (FSH), and thyroid-stimulating hormone (TSH). For hopeful fathers who have sperm issues, a blood test may be recommended to measure levels of testosterone and other hormones. […] Preconception genetic testing. Genetic screening is another tool that helps us reach the right infertility diagnosis. This screening helps us determine whether the hopeful parents have inheritable genetic conditions. If both hopeful parents are carriers of the same disease, we recommend preimplantation genetic diagnosis (PGD) with IVF to ensure that we only transfer healthy embryos.

• #2 Evaluating Infertility | ACOG

  https://www.acog.org/womens-health/faqs/evaluating-infertility

  The most common cause of female infertility is a problem with ovulation. The most common cause of male infertility is a problem with sperm cells and how they function. Other factors that may affect fertility include age, lifestyle, and health conditions. […] Sometimes no cause of infertility is found. This is called unexplained infertility. […] Tests for infertility include laboratory tests, imaging tests, and certain procedures. Imaging tests and procedures look at the reproductive organs and how they work. Laboratory tests often involve testing samples of blood or semen. […] Testing for a man often involves a semen analysis (sperm count). This is done to assess the amount of sperm, the shape of the sperm, and the way that the sperm move. Blood tests for men measure levels of male reproductive hormones.

• #2 Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/male-infertility

  Clinicians should counsel infertile males or males with abnormal semen parameters on the health risks associated with abnormal sperm production. […] For infertile males with specific, identifiable causes of male infertility, clinicians should inform the patient of relevant, associated health conditions. […] Clinicians should advise couples with advanced paternal age (40) that there is an increased risk of adverse health outcomes for their offspring. […] Clinicians should use the results from the semen analysis to guide management of the patient. […] Clinicians should obtain hormonal evaluation including follicle-stimulating hormone and testosterone for infertile males with impaired libido, erectile dysfunction, oligozoospermia or azoospermia, atrophic testes, or evidence of hormonal abnormality on physical evaluation.

• #2 Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I (2020) | American Society for Reproductive Medicine | ASRM

  https://www.asrm.org/practice-guidance/practice-committee-documents/diagnosis-and-treatment-of-infertility-in-men-auaasrm-guideline-part-i-2020/

  Azoospermic men should be clinically evaluated to differentiate genital tract obstruction from impaired sperm production initially based on semen volume, physical exam, and FSH levels. (Expert Opinion) Karyotype and Y-chromosome microdeletion analysis should be recommended for men with primary infertility and azoospermia or severe oligozoospermia (5 million sperm/mL) with elevated FSH or testicular atrophy or a presumed diagnosis of impaired sperm production as the cause of azoospermia. (Expert Opinion) […] Patients with pyospermia should be evaluated for the presence of infection. (Clinical Principle) Antisperm antibody (ASA) testing should not be done in the initial evaluation of male infertility. (Expert Opinion) For couples with RPL, men should be evaluated with karyotype (Expert Opinion) and sperm DNA fragmentation. (Moderate Recommendation; Evidence Level: Grade C)

• #2 Diagnosing Male Infertility | NYU Langone Health

  https://nyulangone.org/conditions/male-infertility/diagnosis

  Blood tests can identify a mans levels of the reproductive hormone testosterone and other related hormones. Hormone imbalances can lead to low sperm counts, cause erectile dysfunction, and lower sex drive. […] Doctors use transrectal ultrasound to detect blockages in the tubes that carry semen out of the body or problems with the prostate, such as benign prostatic hyperplasia, in which the prostate becomes enlarged. […] Doctors may perform blood tests to detect genetic causes of infertility. These tests include chromosome analysis and evaluation of the male sex chromosome, known as the Y chromosome, which can determine if genetic information is altered or missing, thereby affecting sperm production.

• #2 Unexplained Infertility: Tests, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/23187-unexplained-infertility

  Unexplained infertility is when fertility testing hasn’t found a cause to explain a person or couples infertility. Treatments include fertility medication, lifestyle changes, intrauterine insemination (IUI) and in vitro fertilization (IVF). […] Unexplained infertility is a term healthcare providers use to describe infertility after tests reveal no obvious cause for your fertility problems. Providers only diagnose unexplained infertility after both partners have had complete fertility evaluations. […] People diagnosed with unexplained infertility have been trying to get pregnant for at least one year (if you’re younger than 35) or six months (if you’re 35 or older). […] Fertility treatments and assisted reproductive technologies (ART) like IUI (intrauterine insemination) and IVF (in vitro fertilization) can help couples get pregnant.

• #2 Unexplained Infertility: Tests, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/23187-unexplained-infertility

  If a fertility specialist or obstetrician performs comprehensive testing and still can’t find a cause, they may diagnose unexplained infertility. […] Because your healthcare provider can’t identify one cause for infertility, they will most likely recommend treatment based on your fertility test results and their experience with similar couples or individuals. […] The most common treatments fall under the following categories: Assisted Reproductive Technology (ART), Medications, Lifestyle changes, Improved timing of intercourse. […] Some healthcare providers recommend trying longer. This may be a hard treatment plan to understand, especially when you have dreams of starting a family as soon as possible. […] While you can do things to increase your chances of conception, some infertility factors are out of your control.

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