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Infertility is the failure of conception in a couple having regular, unprotected coitus for one year, provided that normal intercourse is occurring not less than twice weekly.
The time period is arbitrary. It relates to the natural rates of conception, ie 80% of couples will be pregnant after 12 cycles. Of those who have not conceived after 12 cycles, about 50% will conceive during a second year of attempted conception. After this second year of attempted conception, the chances of conception in those couples remaining is about 50% in the following four years.
Primary infertility applies to a couple without a prior pregnancy. Secondary infertility is used when the couple have previously succeeded in achieving at least one pregnancy, including abortion and ectopic pregnancy.
The main causes of infertility in the UK are (percent figures indicate approximate prevalence):
In about 40% of cases disorders are found in both the man and the woman. Uterine or endometrial factors, gamete or embryo defects, and pelvic conditions such as endometriosis may also play a role.
A woman of reproductive age who has not conceived after 1 year of unprotected vaginal sexual intercourse, in the absence of any known cause of infertility, should be offered further clinical assessment and investigation along with her partner (1)
A woman of reproductive age who is using artificial insemination to conceive (with either partner or donor sperm) should be offered further clinical assessment and investigation if she has not conceived after 6 cycles of treatment, in the absence of any known cause of infertility. Where this is using partner sperm, the referral for clinical assessment and investigation should include her partner (1)
Offer an earlier referral for specialist consultation to discuss the options for attempting conception, further assessment and appropriate treatment where:
Given the range of causes of fertility problems, the provision of appropriate investigations is critical.
Once a diagnosis has been established, treatment falls into 3 main types: