Infertility

In this section, we provide a brief overview of infertility evaluation. Although primary care physicians may initiate portions of the infertility evaluation and obstetricians-gynecologists may perform the basics of the fertility workup, couples with abnormal test results should be referred to fertility specialists.

Evaluation: Approximately 10% of couples have difficulty conceiving. Couples who are unable to conceive after one year of unprotected intercourse should undergo an evaluation for infertility.

• If the female partner is younger than 35 years, evaluation is recommended after one year; if she is 35 years or older, evaluation is recommended after 6 months.

• Workup for infertility involves identifying the etiology (male factors, female factors, or both).

Treatment: Depending on the identified etiology, fertility treatment options include the following:

• ovulation induction with antiestrogen clomiphene citrate for women with ovulatory dysfunction

• radiographic, endoscopic, or surgical procedures to alleviate tubal obstruction

• medical or surgical ablation of endometriosis

• artificial or intrauterine insemination

• assisted reproduction

Common etiologies and evaluation of infertility are summarized in the following table:

(Source: Evaluation and Treatment of Infertility. Am Fam Physician 2015. Reprinted with permission.)