Infertility: General Considerations

The Challenge

The challenge is to assist couples who experience difficulty conceiving through normal means.

• Scope of the Problem: The inability to conceive and bear children affects 6%–12% of the American population. Under ordinary circumstances, 80%–90% of normal couples conceive during 1 year of attempting pregnancy. Infertility is generally defined as failure to conceive after 1 year of regular, unprotected intercourse (or after 6 months for women older than 30 years). If a woman has a condition known to cause infertility, immediate evaluation is appropriate. Infertility may be further subdivided into primary and secondary types based on the patient’s reproductive history: patients with infertility who are nulligravid are in the primary infertility group; those who have achieved a pregnancy more than 1 year previously, regardless of the outcome of that pregnancy, are grouped in the secondary infertility group. Slightly more than half of infertility patients fall into the primary group.

• Objectives of Management: To establish the relevant cause or causes and develop strategies that result in conception and delivery. With improved understanding of the physiology of conception and a wide range of technologies that may be brought to bear to assist with procreation, 85% of “infertile” couples may be helped.