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Even among fertile couples the
chance of conception in any given month is only about 20 percent, or one chance
in five. To avoid unnecessary testing and treatment, most doctors will not make
the diagnosis of infertility until one year of unprotected intercourse has
failed to result in pregnancy. Cases that involve older couples or fertility
evidence from previous relationships may be easier to diagnose sooner and to
treat more aggressively. Once the diagnosis of infertility is made,
examinations, tests, and medical histories are all used to find its cause.
Male
fertility will often be tested first. The semen is tested to determine the
quantity and health of sperm. Women undergo a physical and pelvic examination,
laboratory tests, and one or more imaging procedures to locate the problem that
may be causing infertility. Testing in women may include exploratory surgery,
which is now made easier by the use of the laparoscope, a small fiber-optic tool
that is inserted through a small incision and enables a physician to inspect the
reproductive system. Advanced ultrasound imaging may also reveal structural or
functional problems. One such condition is endometriosis, in which cells from
the endometrium (lining of the uterus) spread in patches and cysts throughout
the female reproductive system. Tests may also reveal irregular ovulation or
dysfunctional eggs.
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