The major causes of female infertility include ovulatory dysfunction, tubal and peritoneal

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Focused Issue of This Month YoungMin Choi, MD Department of Obstetrics and Gynecology, Seoul National University College of Medicine Email : ymchoi@snu.ac.kr J Korean Med Assoc 2007; 50(5): 400-405 Abstract The major causes of female infertility include ovulatory dysfunction, tubal and peritoneal pathology, uterine pathology, and unexplained factors. For the diagnosis of the underlying cause(s) of female infertility, menstrual history taking, basal body temperature recording, hysterosalphingography, endometrial biopsy, transvaginal ultrasonography, sonohysterography, hysteroscopy, and laparoscopy are clinically useful diagnostic procedures. At present, postcoital test is not a proven valid diagnostic tool in a clinical setting. Keywords : Female infertility; Cause of infertility; Diagnosis of infertility 400

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Figure 1. Schematic diagram of diagnosis for female infertility on menstrual cycle. 403

Choi YM 404

11. Katz DF, Slade DA, Nakajima ST. Analysis of preovulatory changes in cervical mucus hydration and sperm penetrability. Adv Contracept 1997; 13: 143-151. 12. Homer HA, Li TC, Cooke ID. The septate uterus: a review of management and reproductive outcome. Fertil Steril 2000; 73: 1-14. 13. Check JH, Choe JK, Lee G, Dietterich C. The effect on IVF outcome of small intramural fibroids not compressing the uterine cavity as determined by a prospective matched control study. Hum Reprod 2002; 17: 1244-1248. 14. AlInany H. Intrauterine adhesions. An update. Acta Obstet Gynecol Scand 2001; 80: 986-993. 15. PerezMedina T, BajoArenas J, Salazar F, Redondo T, Sanfrutos L, Alvarez P, et al. Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination: a prospective, randomized study. Hum Reprod 2005; 20: 1632-1635. 16. Mastrominas M, Pistofidis GA, Dimitropoulos K. Fertility Outcome after Outpatient Hysteroscopic Removal of Endometrial Polyps and Submucous Fibroids. J Am Assoc Gynecol Laparosc 1996; 3: S29. 17. Polisseni F, Bambirra EA, Camargos AF. Detection of chronic endometritis by diagnostic hysteroscopy in asymptomatic infertile patients. Gynecol Obstet Invest 2003; 55: 205-210. 18. Miller JH, Weinberg RK, Canino NL, Klein NA, Soules MR. The pattern of infertility diagnoses in women of advanced reproductive age. Am J Obstet Gynecol 1999; 181: 952-957. 19. Pavletic AJ, WolnerHanssen P, Paavonen J, Hawes SE, Eschenbach DA. Infertility following pelvic inflammatory disease. Infect Dis Obstet Gynecol 1999; 7: 145-152. 10. Isaksson R, Tiitinen A. Present concept of unexplained infertility. Gynecol Endocrinol 2004; 18: 278-290. 11. Collins JA, Burrows EA, Wilan AR. The prognosis for live birth among untreated infertile couples. Fertil Steril 1995; 64: 22-28. 12. Wathen NC, Perry L, Lilford RJ, Chard T. Interpretation of single progesterone measurement in diagnosis of anovulation and defective luteal phase: observations on analysis of the normal range. Br Med J (Clin Res Ed) 1984; 288: 7-9. 13. Jordan J, Craig K, Clifton DK, Soules MR. Luteal phase defect: the sensitivity and specificity of diagnostic methods in common clinical use. Fertil Steril 1994; 62: 54-62. 14. Duggan MA, Brashert P, Ostor A, Scurry J, Billson V, Kneafsey P, Difrancesco L. The accuracy and interobserver reproducibility of endometrial dating. Pathology 2001; 33: 292-297. 15. Preutthipan S, Linasmita V. A prospective comparative study between hysterosalpingography and hysteroscopy in the detection of intrauterine pathology in patients with infertility. J Obstet Gynaecol Res 2003; 29: 33-37. 16. Soares SR, Barbosa dos Reis MM, Camargos AF. Diagnostic accuracy of sonohysterography, transvaginal sonography, and hysterosalpingography in patients with uterine cavity diseases. Fertil Steril 2000; 73: 406-411. 17. Lindheim SR, Kavic S, Shulman SV, Sauer MV. Operative hysteroscopy in the office setting. J Am Assoc Gynecol Laparosc 2000; 7: 65-69. Peer Reviewer Commentary 405