The current national and World Health Organization definition of infertility is that a couple (husband and wife) who have had normal sexual intercourse without contraception for at least 12 months without conception is infertile in the case of women and in the case of men, infertile. Couples who have never been pregnant in the past are considered primary infertility, while those who have a history of pregnancy in the past are considered secondary infertility. For example, if a remarried couple has a history of miscarriage or childbirth in the woman and no history of fertility in the man, should the woman be called secondary infertility and the man primary infertility? Infertility is a common problem in the field of reproductive health, with a statistical incidence of about 10-15% of couples of childbearing age. What is the need to see an infertility clinic? According to the above-mentioned results, more than 80% of couples with women aged <40 years, not using contraception and having regular sex (2 times a week) will become pregnant within a year; half of those who do not become pregnant in the first year will do so in the second year. Therefore, couples of childbearing age can undergo fertility counseling, or initial tests regarding infertility, when they have normal sexual intercourse and still have not become pregnant in 1 year, and it is recommended that couples visit both. For women over 36 years of age who have been trying to conceive for six months without pregnancy; or who are at risk of infertility, such as irregular menstruation, it is recommended to seek prompt consultation for fertility counseling by a physician who specializes in reproduction. Four steps for the initial diagnosis of infertility For first-time infertility couples, we can initially screen the cause of their infertility through a four-step examination. Step 1: Routine male semen analysis (WHO 5th edition) Routine semen analysis is simple, convenient and inexpensive, so it is used as the first line of initial screening. If the indicators are normal, then it is more reasonable to conduct the examination of the female partner. Some husbands are somewhat macho, or too shy to think they are strong and healthy, and are not willing to do the examination first. Clinically, it is often encountered that the female side has been examined in a big circle, and the result is finally the male side cause. Step 2: Gynecological pelvic examination For the first time infertility female patients need to do a careful gynecological examination during the non-menstrual period to understand the size, position, texture and mobility of the uterus, whether there is tenderness and nodules at the root of the uterosacral ligament, and whether there is abnormal thickening and pressure pain in the bilateral adnexa. If abnormal pelvic signs are found, combined with clinical symptoms, further determination of infertility due to pelvic factors can be made. For example, if tenderness and nodules are found in the uterosacral ligament and endometriosis in the pelvis is suspected, further laparoscopy can be done to clarify the diagnosis. Step 3: Ovulation monitoring Commonly used ovulation monitoring methods include basal body temperature (BBT), vaginal ultrasound ovulation monitoring, serum sex hormone measurement, etc. BBT is a simple self-monitoring method to know whether a woman is ovulating or not, for women with regular menstrual cycle, continuous monitoring of BBT from the first day of the menstrual cycle until the next menstrual period can retrospectively know whether ovulation occurred in the last cycle and whether the luteal function is insufficient. A biphasic BBT indicates ovulation, while a monophasic BBT indicates anovulation. Vaginal B-mode ultrasound is the most accurate and reliable method to monitor the development of follicles and ovulation. Vaginal ultrasound provides basic information about the uterus and the bilateral adnexal (ovaries and fallopian tubes) areas, determines the sinus follicle count in the ovaries, assesses ovarian reserve function, and dynamically monitors ovulation. For infertile women with poor ovulation and anovulation, serum sex hormone measurement can be performed. It is usually chosen on the 2nd to 3rd day of menstruation to measure serum follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), estradiol (E2) and testosterone (T) to understand the ovarian reserve status, and serum progesterone (P) level after ovulation to determine the presence or absence of ovulation, as well as luteal function. Step 4: Tubal patency test Hysterosalpingography (HSG) is the recommended and commonly used method for tubal patency test. The contrast medium is injected into the uterine cavity and fallopian tubes through a contrast tube, and the passage of the contrast medium through the uterine cavity and fallopian tubes is observed under X-ray fluoroscopy.
Under X-ray fluoroscopy, the contrast agent is observed passing through the uterine cavity and fallopian tubes and X-ray films are taken to understand whether the fallopian tubes are open and the shape of the uterine cavity. Contrast agents include oil (iodinated oil) and water soluble (pantethine, iodophor). Iodinated oil is dense, has good contrast effect, and has some therapeutic effect on the fallopian tubes. Laparoscopic tubal lavage is more intuitive and has an accuracy rate of 90-95%. The combined hysteroscopy and laparoscopy is more accurate and reliable for tubal patency examination. Since laparoscopy is an invasive procedure and requires special surgical instruments and is more expensive, it cannot be used as a routine screening tool and is usually only used when there is a suspicious pelvic condition that is valuable for diagnosis and treatment. If none of the above four steps reveal a problem, it is called unexplained infertility. This does not mean that there is no cause, but rather that the current meaningful tests have not revealed a cause, and that some of these patients are simply of low fertility and can occasionally conceive on their own. Some couples end up having to go through IVF in vitro fertilization techniques to discover the cause of infertility. Standardized Infertility Screening and Treatment Because infertility problems are relatively private and people have little knowledge about reproductive health issues, most couples who encounter fertility problems often do not go to a regular hospital but follow media advertisements or seek treatment with prescriptions, falling into the trap of those medical institutions that aim to make a profit.