Evaluation of the Female Fertility

Abstract

Male fertility is a relative notion, as it can only be expressed through a female partner, who herself is endowed with her own fertility. Female fertility, which is of great importance when dealing with infertility of the couple associated with male subfertility, becomes critical when AIH is considered, for at least two main reasons:

• 1. A significant number of pregnancies are associated with sperm parameters considered as low. Sperm concentration is reported as lower than 20 million spermatozoa per ml in as many as 5% of fertile couples (Mac Leod and Gold 1951; Rehan et al. 1975) and sperm motility inferior to 10% in as many as 10% of fertile couples (Page and Houlding 1951). Male subfertility may be masked by an excellent female fertility, as demonstrated by spermiograms taken prior to vasectomy in fertile couples (Smith et al. 1978). Aside from the possible intervention of another male partner, pregnancies associated with subfertile semen can only occur through prolonged exposure and/or a very high female fertility. The latter possibility seems to be supported by the percentage of fertile couples with subfertile semen, which may have increased in the past 25 years, possibly through a better evaluation and management of female causes of hypofertility (Zuckerman et al. 1977).

• 2. Artificial insemination with donor semen (AID), a situation where a normal sperm has replaced the supposed causative factor of infertility, is associated with a high failure rate. The overall pregnancy rate, either with fresh or frozen sperm, ranges from 35 to 45% in most recent comprehensive surveys (Friedman 1977; Sulewski et al. 1978). Accordingly, at least half of the patients engaged in AID procedures will not conceive despite an adequate sperm concentration, motility and morphology. Most reports on AID emphasize the role of female fertility in the pregnancy rate; this rate drops to 20% when an associated female subfertility factor is involved (Friedman 1977). On the other hand, another 22% is obtained after correction of pelvic disease (Sulewski et al. 1978) and the pregnancy rate may reach 67% after elimination of those women with associated causes of subfertility (Friedman 1977). The pregnancy rate is also higher in women with demonstrated fertility (Dixon and Buttram, 1976).