Cryptic infertility and therapeutic options

Abstract

Too often infertile patients are given a "herd type" fertility investigation which ultimately leads to expensive, time consuming, and risky in vitro fertilization. However, attention to certain simple details available by non-invasive methods, e.g., checking for premature luteinization, luteinized unruptured follicle syndrome, or performing the post-coital test at the appropriate interval, can lead to a quick solution of the infertility problem. Caution about persistent infertility related to iatrogenic factors, e.g., development of poor post-coital tests or excessively thin endometrium from clomiphene citrate, or development of luteinized unruptured follicle syndrome or premature luteinization by taking follicle maturing drugs, or creating a hostile environment from taking follicle maturing drugs when the woman already made a mature follicle (and would have had a higher success rate with luteal phase support with progesterone) will help achieve pregnancies without necessarily proceeding to the most expensive and invasive procedure of in vitro fertilization. Finally, many wasted cycles of treatment could be avoided by including the simple but very important hypo-osmotic swelling test and measurement of sperm autoantibodies with the first initial semen analysis.