DEFINITION, PREVALENCE & ETIOLOGY

DEFINITION

– Inability to conceive after 1 year of regular unprotected intercourse (2-3 times/week)

PREVALENCE

• 1 in 7 couples in the UK are affected
• 40% of cases: issues from both partners
• 80% conceive in the first year if the female is <40 years
• 50% of the remaining conceive in the second year

ETIOLOGY

4 main causes:

• Male factors: 30% of cases
• Ovulatory disorders: 25% of cases
• Tubal factors: 20% of cases
• Uterine/fibroids: 10% of cases

Male causes:

• Primary testicular failure: chemotherapy, radiotherapy, Klinefelter syndrome
• Obstructive azoospermia
• Ejaculatory/erectile dysfunction
• Sperm quality issues Female causes:
• Ovulatory:
  • Hypothalamic-pituitary disorders: hypogonadotropic hypogonadism

(Kallmann syndrome linked with anosmia), Hypothalamic amenorrhoea o PCOS

• Endocrine: Cushing’s, uncontrolled diabetes, CAH, thyroid disorders

• Tubal: PID, endometriosis
• Uterine: adhesions, polyps, submucous fibroids