Exploration of infertility in 2012

Abstract

The exploration of an infertile couple is multi
dimensional and takes into account various notions
of both cultural, sociological, psychological, sexological, physiological and pathological conditions.
While the initial assessment, including a study of
ovulation, pelvic ultrasound, hysterosalpingography, spermogramme with spermocytogramme and post
coïtal test, remains unchanged for à number of
years, some tests as part of the assessment of second
line draw attention. The value of systematic laparoscopy in infertility assessment is still subject to
debate. In our opinion, laparoscopy is of course
indicated in infertility assessments not only when
anomalies are revealed by hysterosalpingography
but also in the following circumstances: past history
of infection (especially a positive Chlamydia antibody blood test) and/or pelvic surgery (a significant
risk of adhesions), unexplained secondary infertility,
unexplained infertility after the age of 38 and failure
of 3 cycles of good-quality intra-uterine inseminations. In addition, new markers have recently emerged to assess ovarian reserve. With the rising age of
desire for motherhood, the concept of ovarian age is
therefore fundamental and evaluation will be performed when the patient has more than 35 years, cycle
disturbances, personal or familial history of premature ovarian failure, or as a management in Assistive
Reproductive Technologies is considered. The current markers that, combined with the determination
or FSH and oestradiol at the beginning of the cycle,
appear to be most relevant to the evaluation of ovarian reserve, are represented by the anti-Müllerian
hormone and the antral follicule count. They are
used to determine the prognosis and urgency of
care, they also have an interest in defining the modalities of treatment, unfortunately without being able
to predict the chances of pregnancy while the combination of these markers to increase power seems
to have no interest.