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 the patient's management which aims to achieve development of a single follicle and subsequent ovulation in a woman with 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
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Endocrinology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Pearl Toh, 20 Jul 2018
Women with pre-eclampsia or gestational hypertension during their first pregnancy had an increased risk of developing chronic hypertension, type 2 diabetes (T2D), and hypercholesterolaemia than those who were normotensive during pregnancy, according to a study. The risk persisted for several decades later, signalling these hypertensive disorders of pregnancy (HDP) as red flags for cardiovascular (CV) health for life.
Roshini Claire Anthony, 30 Jul 2018

Canagliflozin may provide a renoprotective effect in individuals with type 2 diabetes (T2D) and a history of cardiovascular disease (CVD), according to results from the CANVAS* Program.

Stephen Padilla, 31 Jul 2018
Patients with type 2 diabetes (T2D) treated with sulphonylureas as second-line drugs are at an increased risk of myocardial infarction (MI), all-cause mortality and severe hypoglycaemia compared with those who remained on metformin monotherapy, a recent study has found.
22 Jul 2018
There appears to be a nonlinear relationship between total oestradiol and free oestradiol and all-cause mortality among older men, according to data from the Three-City cohort study. Specifically, the association is stronger for cardiovascular disease mortality and nonexistent for cancer mortality.