OG28.1 | Infertility Evaluation and Management — Summary & Reflection

KEY TAKEAWAYS

Infertility (failure to conceive after 12 months, or 6 months if age >35) is classified as primary or secondary and has multiple simultaneous causes requiring parallel investigation of both partners. Female causes include ovulatory dysfunction (most commonly PCOS), tubal/peritoneal disease (PID, endometriosis), uterine abnormalities (fibroids, Asherman), and cervical factors. Male causes span pretesticular (hypogonadotrophic hypogonadism), testicular (varicocele, orchitis, genetic), and post-testicular (obstruction) categories. Unexplained infertility accounts for 15–30% of couples. Investigation is simultaneous and systematic: semen analysis using WHO 2021 criteria, ovulation confirmation (mid-luteal progesterone ≥10 nmol/L or follicle tracking), hormonal profile (FSH, LH, AMH, TSH, prolactin), tubal patency (HSG/SSG/laparoscopy-dye), and uterine cavity assessment (hysteroscopy/USS). Management is cause-specific: letrozole is first-line for anovulatory infertility (PCOS); laparoscopic surgery or IVF for tubal factor; IUI or ICSI/IVF for male factor; expectant management progressing to ART for unexplained infertility. Age and ovarian reserve are the dominant prognostic determinants.

REFLECT

Consider the case of Priya and Suresh from the opening scenario. Priya's irregular cycles and hirsutism suggest PCOS with anovulation; Suresh's occupational heat exposure and smoking are known gonadotoxins. Reflect: if you had only evaluated Priya and prescribed clomiphene without checking Suresh's semen analysis, what would you have missed? How does the simultaneous couples approach change the management pathway? Now consider the emotional dimension: Priya has been told by family that it is 'her fault'. How would you, as the clinician, reframe infertility as a couples diagnosis without dismissing Suresh's role or adding to stigma? What counselling resources would you offer? (Kolb: Reflect on your assumptions about who is 'the infertile one' — challenge the single-partner mindset in your future practice.)