The Biochemistry of Infertility
The causes of infertility are numerous, and the pursuit of a definitive diagnosis of the etiology is still a lengthy process, requiring persistence and patience in both patient and doctor. Patients present with either regular menstrual pattern and infertility after a long marriage or with disturbed or absent menstruation, sometimes with other abnormal features such as hirsutism, galactorrhea, and loss of, or failure of development of, secondary sex characteristics. A surprising number of patients present with problems related to ignorance of the correct method in intercourse, with frigidity, or with premature ejaculation in the husband, and these patients should be sought out at an early stage to prevent extensive and unnecessary investigation. Clinics for the investigation and management of infertility condition are best run jointly by an endocrinologist and an obstetrician, with the cooperation of a well-equipped and experienced hormone laboratory.