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Infertility
is inability of a couple to conceive after 1 yr of unprotected intercourse.
Overall, frequent, unprotected intercourse results in conception for 50% of couples within 3 mo, for 75% within 6 mo, and for 90% within 1 yr. Incidence of infertility is increasing, in part reflecting deferral of childbearing until women are older. Primary causes of infertility are sperm disorders (35% of couples), decreased ovarian reserve or ovulatory dysfunction (20%), tubal dysfunction and pelvic lesions (30%), abnormal cervical mucus (≤ 5%), and unidentified factors (10%). Inability to conceive often leads to feelings of frustration, anger, guilt, resentment, and inadequacy.
Couples wishing to conceive are encouraged to have frequent intercourse for the few days when ovulation is most likely, probably midway between menstrual cycles. Measuring morning body temperature daily can help determine when ovulation is occurring in women with regular menstrual cycles. A decrease suggests impending ovulation; an increase of ≥ 0.5° C suggests ovulation has just occurred. Commercially available luteinizing hormone (LH) prediction test kits, which identify the midcycle LH surge, can also help determine when ovulation occurs. Use of caffeine and tobacco, which can impair fertility, is discouraged.
Diagnosis begins with history, examination, and counseling of both partners. Men are evaluated for sperm disorders, and women for ovulatory and tubal dysfunction and pelvic lesions.
Support groups for couples (eg, American Fertility Association, RESOLVE) may help. If the likelihood of conceiving is low (usually after 2 yr of treatment), the clinician should mention adoption.
Last full review/revision November 2005
Content last modified November 2005
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