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Infertility: evaluation and treatment
Infertility evaluation examines both partners in parallel — ovulation, ovarian reserve, tubes and sperm — because in about a third of couples the problem lies with the man, and there is often more than one factor.
Why it matters in the exam
Exam questions start with the definition: no pregnancy after 12 months of regular intercourse without contraception, or after 6 months in a woman aged 35 or more; above age 40, or with a known cause (amenorrhoea, pelvic disease, chemotherapy), evaluation starts immediately. Next comes the question of the next test: semen analysis for the man, proof of ovulation (mid-luteal progesterone), ovarian reserve (AMH and antral follicle count) and a test of tubal patency (hysterosalpingography, HSG).
Treatment follows the cause. Anovulation — ovulation induction with letrozole or clomiphene. Blocked tubes or a severe sperm defect — IVF, with intracytoplasmic sperm injection (ICSI) for a severe male problem. A hydrosalpinx lowers the chance of IVF success, so the tube is removed before embryo transfer. An important complication of ovarian stimulation is ovarian hyperstimulation syndrome (OHSS): a swollen abdomen, ascites, haemoconcentration and a risk of thrombosis. In a man with no sperm on testing, obstruction (for example congenital absence of the vas deferens with CFTR) is distinguished from failed production, and genetic testing is done.
Key points
- Definition: 12 months, or 6 months from age 35.
- Parallel work-up: sperm, ovulation, ovarian reserve, tubes, uterus.
- Anovulation → letrozole or clomiphene.
- Blocked tubes or a severe male problem → IVF / ICSI.
- OHSS: ascites, haemoconcentration, thrombosis risk.
Summary table
| Component | Test | Abnormal finding | Treatment |
|---|---|---|---|
| Sperm | Semen analysis (WHO 2021 values) | Concentration below 16 million per mL, total motility below 42%, normal forms below 4% | Insemination, IVF or ICSI by severity |
| Ovulation | Mid-luteal progesterone; cycle history | Low progesterone, irregular cycles | Letrozole or clomiphene |
| Ovarian reserve | AMH, antral follicle count, day 3 FSH | Low AMH, high FSH | Early referral for IVF |
| Tubes | HSG | Blockage or hydrosalpinx | IVF; remove a hydrosalpinx before transfer |
| Uterus | Ultrasound, hysteroscopy | Polyp, septum, submucous fibroid, adhesions | Hysteroscopic resection |
| OHSS | After ovarian stimulation | Swollen abdomen, ascites, high haematocrit | Fluids, thrombosis prevention, drainage of ascites; prevention by freezing embryos |
Free exam questions
במהלך בירור אי פריון, גבר אובחן כנשא של Y MICRODELETION . מעורבות של איזה מבין האזורים הבאים בכרומוזום Y מחייבת המלצה למעקב ארוך טווח מחשש לממאירות של האשך? (the question as examined, in Hebrew)
- א. AZFa
- ב. AZFb
- ג. AZFc
- ד. AZFd
בת 37, עומדת בפני התחלת מחזור הפריה חוץ גופית בשל אי פוריות ע .ל רקע מכני איזה מהמדדים הבאים הוא בעל הרגישות הגבוהה ביותר לחיזוי שאיבה של פחות מארבע ביציות? (the question as examined, in Hebrew)
- א. AFC = 7
- ב. AMH = 0.5 ng/mL
- ג. FSH = 11 IU/L ביום 3 למחזור ה ו וסת
- ד. Estradiol = 300 pMol/L ביום 3 למחזור ה ו וסת
מטופלת מודאגת מכך שמזה 3 חודשים לא מצליחה להרות, למרות קיום יחסי מין באופן סדיר ותדיר. באיזה מקרה אפשר להרגיע אותה ללא צורך בהמשך בירור אי פיריון? (the question as examined, in Hebrew)
- א. המטופלת הנה בת 41
- ב. למטופלת ווסתות לא סדירות ושיעור יתר
- ג. המטופלת הטרוזיגוטית למוטציית פקטור 5 ליידן
- ד. בסקר גנטי נמצאה למטופלת נשאות לתסמונת X שביר
Example question from the licensing exam (IMLE)
As part of an azoospermia investigation, a genetic diagnosis of Klinefelter syndrome is obtained. What fertility treatment should be offered to the patient?
- A. Testosterone
- B. Gonadotropins
- C. GnRH pump
- D. Sperm donation
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Sources
- ASRM Committee Opinion, 2020 — Definitions of infertility and recurrent pregnancy loss
- ASRM Committee Opinion, 2015, updated 2020 — Diagnostic evaluation of the infertile female
- WHO laboratory manual for the examination and processing of human semen, 6th edition (2021) — Reference limits
- Speroff's Clinical Gynecologic Endocrinology and Infertility, 9th edition (2019) — Female Infertility; Male Infertility
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.