infertility
INFERTILITY

Infertility is when a couple of reproductive age is unable to conceive after a year or more of regular unprotected intercourse.

It can be primary if no pregnancy has ever occurred or secondary if pregnancy has occurred irrespective of the outcome.

Ovulation induction is part of patient's management which aims to achieve development of a single follicle & subsequent ovulation in woman w/ anovulation.

Differential Diagnosis

Impaired fertility caused by other endocrine dysfunctions:

  • Menstrual disorders and infertility can also be manifestations of underlying endocrine dysfunction
    • Screening for these diseases is not routine but required if suggested in the history and physical exam
  • Hyperthyroidism elevates LH and FSH, causes loss of mid-cycle LH peak leading to anovulation and low progesterone
  • Hypothyroidism causes menstrual irregularity, occasionally anovulation and rarely amenorrhea
  • Hypersecretion of growth hormone (GH) in acromegaly can lead to loss of fertility
  • Diabetes mellitus can reduce gonadotropin-releasing hormone (GnRH) and LH response which may lead to amenorrhea and oligomenorrhea
  • Adrenal disorders also interfere with normal reproductive function and can complicate pregnancy
    • Eg hyperandrogenism in congenital adrenal hyperplasia, decreased libido and amenorrhea in adrenal insufficiency, impaired LH response in Cushing’s syndrome
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