Epidemiology and initial assessment

Mark Hamilton
In: Management of Infertility for the MRCOG and Beyond · 2014 · pp. 1–12 · doi:10.1017/cbo9781107445178.003 · W2475612250
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This chapter reviews infertility prevalence, highlights the need for ovulation and semen analysis in initial assessments, and outlines diagnostic categories and treatment strategies like ovulation induction.

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This chapter in “Management of Infertility for the MRCOG and Beyond” reviews the epidemiology of infertility and the principles of initial assessment of infertile couples, emphasizing the need for efficient referral pathways and region-wide, standardized basic investigation protocols. It describes a common definition of infertility as failure to conceive after 12–24 months of exposure, noting that conception probabilities in the general population imply about 85% of couples conceive by 1 year and about 92% by 2 years, and that delays and repeated tests are particularly demoralizing. The limitation explicitly implied is that the content is a framework-focused chapter on assessment and prevalence, not an original study providing condition-specific efficacy or outcomes. This paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

This chapter discusses the prevalence of infertility and the importance of the initial assessment of the infertile couple. Education of the public about the known decline in fertility that occurs with age, particularly in women older than 35 years, is important. The preliminary investigation centres on the need to demonstrate that the woman is ovulating. Semen analysis remains the most important means of assessment for male. In the fertility clinic setting, a pelvic ultrasound examination may be useful. Diagnostic categories in most studies include male factors, disorders of ovulation, tubal factors, endometriosis and uterine factors related to infertility, and unexplained infertility. Ovulatory disorders, often associated with irregular menstruation, are associated with reduced chances of natural conception. Ovulation induction provides good chances of success if there are no other complicating factors such as tubal compromise or severe impairment in sperm quality.
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- Frontmatter - Contents - About the authors - Preface - Acknowledgements - Abbreviations - 1 Epidemiology and initial assessment - 2 Male factor infertility - 3 Ovulatory disorders - 4 Tubal infertility - 5 Endometriosis-related infertility - 6 Uterine factors in infertility - 7 Unexplained infertility - 8 Assisted reproduction – preparation and work-up of couples - 9 Assisted reproduction – clinical and laboratory procedures - Index Published online by Cambridge University Press: 05 June 2014 Book contents - Frontmatter - Contents - About the authors - Preface - Acknowledgements - Abbreviations - 1 Epidemiology and initial assessment - 2 Male factor infertility - 3 Ovulatory disorders - 4 Tubal infertility - 5 Endometriosis-related infertility - 6 Uterine factors in infertility - 7 Unexplained infertility - 8 Assisted reproduction – preparation and work-up of couples - 9 Assisted reproduction – clinical and laboratory procedures - Index Introduction This chapter discusses the prevalence of infertility and the importance of the initial assessment of the infertile couple. Efficient mechanisms for referral and investigation and adoption of region-wide protocols of basic investigation are requirements for those involved in the planning of services, and should be founded upon good liaison between medical and nursing staff in both primary and secondary care. Adherence to such protocols facilitates appropriate and timely investigation along standardised paths, minimising the risks of delay and repetition of tests, which couples find particularly demoralising. Once a diagnosis is reached, it should be possible to offer the infertile couple an accurate prognosis and the opportunity to consider the issues relevant to treatment choices for their particular situation. Epidemiology A common definition of infertility is the inability of a couple to conceive following 12–24 months of exposure to pregnancy. The length of exposure time considered is determined by the observation that in the general population, which would include a proportion of couples with infertility, one would expect the chance of conception in any individual cycle to be around 20%. Thus by 1 year of exposure about 85% of couples would have achieved conception and by the time 2 years has elapsed some 92% would have conceived. In practical terms, the failure to achieve pregnancy causes enormous distress to those affected. For people with fertility problems, using a definition of 1 year to describe infertility is usual and most will have sought medical advice or assistance by that time. - Type - Chapter - Information - Management of Infertility for the MRCOG and Beyond , pp. 1 - 12Publisher: Cambridge University PressPrint publication year: 2014 Accessibility compliance for the PDF of this chapter is currently unknown and may be updated in the future. To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service. - Epidemiology and initial assessment - - Book: Management of Infertility for the MRCOG and Beyond - Online publication: 05 June 2014 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox. - Epidemiology and initial assessment - - Book: Management of Infertility for the MRCOG and Beyond - Online publication: 05 June 2014 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive. - Epidemiology and initial assessment - - Book: Management of Infertility for the MRCOG and Beyond - Online publication: 05 June 2014

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