Evaluation and treatment of the infertile couple

G Forti, C Krausz - The Journal of Clinical Endocrinology & …, 1998 - academic.oup.com
The Journal of Clinical Endocrinology & Metabolism, 1998academic.oup.com
THE increase in demand for infertility services in Western countries is probably due to
different factors: 1) the tendency of women to delay childbearing because of their work so
that desired reproduction is condensed into a shorter interval than before and at a more
advanced age (ie 30 or even 35 yr), which by itself is a negative prognostic factor for the
woman's fecundability; 2) an increase of effective treatments by assisted reproductive
techniques (ARTs); 3) an increased awareness of such treatments. The prevalence of …
THE increase in demand for infertility services in Western countries is probably due to different factors: 1) the tendency of women to delay childbearing because of their work so that desired reproduction is condensed into a shorter interval than before and at a more advanced age (ie 30 or even 35 yr), which by itself is a negative prognostic factor for the woman’s fecundability; 2) an increase of effective treatments by assisted reproductive techniques (ARTs); 3) an increased awareness of such treatments. The prevalence of infertile couples differs according to the definition of couple infertility. If we accept the most commonly used definition, ie the lack of pregnancy after 1 yr of unprotected regular intercourse, infertile couples represent about 10–15% of all couples. According to the definition of the European Society for Human Reproduction and Embryology, ie the lack of pregnancy within 2 yr by regular coital exposure, the prevalence of infertile couples in Europe and North America is approximately 5–6%(1).
The causes of infertility can be divided into four major categories: 1) the female factor; 2) the male factor; 3) combined factors; 4) unexplained infertility. It is difficult to assign exact percentage to each of these categories; however, it is generally reported that in approximately 35% of cases, infertility is mainly due to a female factor, in 30% to a male factor, in 20% to abnormalities detected in both partners, and in 15% of cases no diagnosis can be made after a complete investigation (Table 1). In some couples there is no possibility of natural conception because of sterility of the male (azoospermia or lack of ejaculation) or of the female (ovarian failure, tubal occlusion, absence of the uterus). Minor degrees of fertility impairment are not necessarily associated with couple infertility when present in only one partner but may reduce the couple’s fertility when present in both partners. The aim of the present review is to give the general endocrinologist a brief overview of a modern diagnostic and therapeutic approach to the infertile couple.
Oxford University Press