The World Health Organization defines infertility as a failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. It is estimated to affect between 8-12% of reproductive-aged couples worldwide. Because fertility in women is known to decline steadily with age, women aged 35 years or above who fail to conceive after 6 months of unprotected sex should seek professional opinion. Some health problems also increase the risk of infertility. Therefore, couples with the following symptoms or medical history should not delay seeing a doctor when they are trying for a pregnancy:
Irregular periods or no menstrual periods;
Very painful periods;
Pelvic inflammatory disease;
Previous surgery to the ovaries, chemotherapy or radiotherapy to the pelvis;
More than one miscarriage;
Suspected male factor (i.e., history of testicular trauma, hernia surgery).
The doctor will begin by collecting a medical and sexual history from the couple. The initial evaluation usually includes a semen analysis, a pelvic ultrasound scan, tubal evaluation usually by means of a hysterosalpingogram, and ovarian reserve tests (ORT).
Ovarian reserve or ovarian function plays a crucial role in achieving pregnancy following any treatment in infertile women. The estimation of ovarian reserve is routinely performed through various ovarian reserve tests (ORT) in an effort to predict the ovarian response to stimulation during assisted reproductive technology treatments namely IVF. The most commonly used markers of ovarian function include follicle stimulating hormone (FSH) value on day 2 to 3 of the menstrual cycle, anti-müllerian hormone value (AMH), and antral follicle count (AFC) using a transvaginal ultrasound scan.