Causes of Female Infertility - Differential Diagnosis Algorithm

Uterus - HSG or SHG or hysteroscopy:

 • Fibroids/polyps

 • Asherman's syndrome

 • Congenital anomalies

 • Adenomyosis

 • Unfavourable cervical mucous

 • Cervical stenosis

Fallopian Tube - HSG or SHG or laparoscopy:

 • Pelvic inflammatory disease

 • Endometriosis

 • Adhesions

 • Previous tubal pregnancy

 • Congenital Anomalies

Normal FSH:

 • Polycystic ovarian syndrome

 • Obesity

Increased FSH:

 • Premature ovarian failure

 • Premenopausal changes

 • Turner's syndrome

Decreased FSH - Hypothalamic:

 • Weight loss/malnutrition

 • Excessive exercise

 • Stress/psychosis

 • Systemic disease

Decreased FSH - Hypopituitarism:

 • Hypothyroidism

 • Hyperprolactinemia

 • Tumors (e.g. Prolactinoma)



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