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Infertility can be defined as failure to conceive after having regular unprotected sex for 12 months or more. If the female partner is over 35, they can approach a doctor for fertility evaluation after six months of trying.

Fertility evaluations begin with a proper history and a thorough examination. Important aspects of the evaluation include:

1. Menstrual history - The length and characteristics of the cycle. If you have regular menstrual cycles with breast pain, pain during ovulation, and bloating of the stomach, this would suggest that your ovaries are producing ovum regularly. The diagnostic process will continue along different lines.

2. Medical, surgical and gynecological history - (which should include sexually transmitted diseases, pelvic inflammatory diseases and treatment of abnormal pap smears). Your doctor should evaluate you for symptoms of thyroid disease, any abnormal milk-production by your breasts, any abnormal distribution of body hair, stomach or pelvic pain, pain during menstruation and pain during sex.

3. Family History: If any of the family members have infertility, birth defects, genetic mutations or chromosomal abnormalities, this can inform your doctor during the diagnostic process.

4. Personal and lifestyle history: This should include things such as age, occupation, exercise, stress, dieting and changes in weight, smoking, and alcohol use, all of which can affect fertility.

The basic infertility evaluation should consist of:

1. A full semen analysis.

2. Assessing whether your ovaries are normally producing ova by either history or lab testing.

3. Determining whether your fallopian tubes are patent and your uterine cavity has no abnormality, using a test known as hysterosalpingogram.

If the doctor suspects endometriosis or pelvic adhesions as one of the causes of infertility, then a diagnostic laparoscopy is warranted. Endometriosis is the abnormal presence of menstrual tissue outside of the uterine cavity.

Adhesions are scar tissue after any injury or surgery, causing deformation in the size and shape of the reproductive organs.

A diagnostic laparascopy is a procedure in which a camera is inserted into your abdomen to see whether you have endometriosis in any part in the abdomen, or to see if there are any adhesions.

Doctors should always evaluate both partners, unless one partner was already diagnosed with a condition that leads to infertility.

Male infertility is generally divided into four categories:

1. Diseases of pituitary or hypothalamus: Both of these are present in the brain and give rise to specific symptoms and lab tests (one to two percent).

2. Testicular disease (30 to 40 percent).

3. Disorders of sperm transport(10 to 20 percent).

4. Sometimes abnormal semen analysis test results may not have any cause (40 to 50 percent).

Now I will tell you about unexplained infertility:

Try these simple things before trying ones which have side-effects:

1. Stop cigarette smoking (male and female).

2. The female partner should maintain a Body Mass Index of 20 to 27. Losing or gaining weight can sometimes result in a return of fertility.

3. Neither partner should consume more than four standardized drinks per week.

4. Reduce caffeine intake to no more than 250mg daily.

You can try these before consulting your doctor for other options. If you are below 35, expectant management might be a wise thing before trying treatments which might have side-effects.

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