How to Know If Woman Is Infertile ?

The first and crucial step in the diagnostic workup of the couple with fertility problems is the case history because it is both simple and important. At this stage, the couple of reproductive age should be asked about their sexual activity. Do they try to get pregnant and for how long they have been trying? Once a diagnosis of infertility has been estab-lished other questions, ideally for both partners, should be asked. They include: the age of woman, knowing that fertility declines with age, and female age is one of the key prognostic factors both for the diagnosis and treatment outcome.

The gynaecological history should contain questions about the menstrual cycle. In women younger than 35 the regular menstrual cycle might speak for ovulating cycle. Menorrhagia can suggest the presence of polyps or uterine fibroids, whereas severe dysmenorrhea might indicate endometriosis. The irre¬gularity of menstruation or absence of menstrual bleeding might be a sign of the lack of ovulation or pathology of endometrium, such as tuberculosis or intrauterine adhesions. It should not be forgotten that the woman might be pregnant or have primary ovarian insufficiency (POI). Women with recurrent miscarriages or with pregnancy complications might require different diagnostic workup. The further diagnostic procedure in women should involve precise physical examination, and in many cases also the endovaginal pelvic ultrasound.

There is a large number of tests for diagnosing infertility causes. According to UnitedHealthcare recommendations the following tests or procedures are proven and medically necessary for diagnosing infertility in females: antral follicle count, clomiphene citrate challenge test, concentrations of antimullerian hormone (AMH), follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), thyroid-stimulating hormone (TSH), steroids — estradiol and progesterone levels. Additionally, there are also procedures such as hyster- osalpingogram (HSG), diagnostic hysteroscopy and diagnostic laparoscopy with or without chromotubation.

The following tests are described as unproven: estimations of Inhibin B and uterine/endometrial receptivity testing. There is insufficient evidence regarding the use of these tests and more research is needed to support the claim of positive outcomes in infertility treatment. According to the literature, one and commonly accepted ‘minimal diagnosis set’ for infertility is non-existent. There are only general principles re¬commending the selection of the diagnostic steps for couples with infertility.

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