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PubMed2002

Infertility in Shanghai: prevalence, treatment seeking and impact.

To assess the level of treatment seeking and impact on marriage of infertility among newly married couples of Shanghai, China, a total of 7872 newly married couples, enrolled between 1987 and 1988, were followed-up for 5 years. The prevalence of infertility (no fertile conception after 24 months of unprotected intercourse) was found to be 5.1%. Couples' age at marriage, education, prior induced abortion, miscarriage, use of IUD or hormonal contraceptives and medical problems of both partners were associated significantly with infertility. About 57% of infertile couples sought infertility treatment and subsequently had a higher probability of childbirth (42%) than non-seekers (28%). Husband's education, induced abortion and both partner's previous medical problems were associated significantly with infertility treatment seeking. Moreover, infertile couples were 2.2 times more likely to divorce than their counterparts (95% CI 1.52-3.18). We conclude that infertility in Shanghai is modest, but a substantial number of infertile couples would not like to seek infertility treatment. Further research is needed on this subject.

Adult↗
PubMed2003

High prevalence of male infertility in southeastern Nigeria.

Three hundred and fourteen Nigerian couples were evaluated thoroughly for the cause of their infertility in our clinics located at Nnewi and Awka in Southeastern Nigeria. Two hundred and four (65.0%) of them had primary infertility and 110 (35%) had secondary infertility. The median duration of the infertility was 5 years and majority of the female patients (67.2%) were aged between 25 and 34 years. A positive male factor alone was found in 133 (42.4%) couples and female factor alone in 81 (25.8%) couples (P<0.01). Sixty-five (20.7%) couples had a combination of male and female factors, while the cause of infertility was unexplained in 35 (11.1%) couples. Oligozoospermia (35.9%) and asthenozoospermia (32.3%) were the most common aetiological factors responsible for male infertility. Tubal occlusion (49.0%) was the most common cause of female infertility. Genital tract infection resulting from sexual promiscuity and poorly treated sexual transmitted diseases were responsible for these abnormalities. In this part of the world, the wife is commonly blamed whenever there is infertility. However, this study has revealed the greater contribution of male factors to infertility. More attention should be paid to male partners whenever a couple presents for infertility. Men should also be a major target of any intervention aim at prevention.

Adult↗
PubMed2004

A case-control study of ovarian cancer in relation to infertility and the use of ovulation-inducing drugs.

The authors conducted a population-based, case-control study among women aged 35-54 years to assess the influence of infertility and use of ovulation-inducing drugs on ovarian cancer risk. The study was conducted from 1994 to 1998 in three regions (metropolitan Atlanta, Georgia, Detroit, Michigan, and Seattle, Washington) and included 378 cases and 1,637 controls. Data were obtained through in-person interviews, and analysis was conducted using unconditional logistic regression. Among parous women, the authors observed no association of cancer risk with a history of infertility, medical evaluation for infertility, specific types of infertility, or use of ovulation-inducing drugs. Among nulliparous women, risk was increased among women with a history of infertility (odds ratio = 1.6, 95% confidence interval: 1.0, 2.6), particularly when infertility first became manifest relatively late in reproductive life (for first infertility at > or =30 years of age: odds ratio = 2.2, 95% confidence interval: 1.1, 4.5); risk was not associated with medical evaluation for infertility, specific types of infertility, or use of ovulation-inducing drugs. Findings were similar when borderline and invasive epithelial tumors were considered separately. While the results of this study support the hypothesis that a subset of nulliparous women who experience infertility may be at increased risk of ovarian cancer, the reasons for this increase in risk remain unclear.

Adult↗
PubMed2005

The use of enzyme-linked immunosorbent assay for detection of Mycoplasma hominis antibodies in infertile women serum samples.

BACKGROUND: Besides Chlamydiae trachomatis and Mycoplasma genitalium, Mycoplasma hominis may also cause infertility due to damage of the Fallopian tubes. Therefore serum samples from infertile women were analyzed for antibodies to M. hominis. METHODS: Sera from 304 infertile women were investigated for seropositivity to M. hominis by immunoblotting and a developed ELISA. Women were classified into groups based on the type of infertility: infertile due to lack of passage in Fallopian tubes (TFI, tubal factor infertility), an infertile male partner (MFI, male factor infertility) and unexplained infertility (UFI, unexplained factor infertility). Three M. hominis isolates were used in the immunoblotting analysis and clear differences in patient immunoprofiles were observed between two isolates. For the ELISA we used a mixture of Triton X-114 extracted membrane proteins from those two M. hominis isolates as antigen. RESULTS: Ninety-seven sera (32%) were seropositive to M. hominis when tested by the ELISA. There was a significant correlation between TFI and seropositivity to M. hominis (P = 0.0015, OR = 2.21, CI = 1.35-3.61). We compared the seropositivity of 304 patients to M. hominis with the presence of antibodies against two other bacteria Chlamydiae trachomatis and Mycoplasma genitalium and there was no statistical correlation between those bacteria and M. hominis. CONCLUSION: Our results indicate that M. hominis may be an independent predictor of TFI.

Antibodies, Bacterial↗
PubMed1976

Psychophysiologic infertility: an overview.

It has been recognized for centuries that commotion in the mind very often is reflected in the functions of the body. A few years ago 50% of cases of infertility were classified as emotionally determined. Today only about 5% are so classified because the identification of defects in chemistry or physiology rules out the diagnosis. Many infertile women with physical defects have significant emotional disorders, and many infertile women with no demonstrable physical defect have no significant emotional disorders. The diagnosis of psychophysiologic infertility can be made only after identification of intrapsychic conflicts arising from cultural, environmental, or experiential factors that have modified function, chemistry, or structure. The gradual elucidation of the functions of the limbic system and more understanding of the roles of the neurotransmitter amines have led to the present understanding of the psychophysiology of infertility. It has been shown that the neurotransmitter amines influence the production of reproductive hormones and hormone-releasing factors. Many types of stress change the concentration, production, and modification of these transmitter compounds. Investigators have tried without success to identify specific emotional problems that eventually produce infertility. Infertile women do have more emotional disorders, however, and some seem to be cause-effect related. Infertility protects some women against significant psychic conflicts and becomes a defensive process. Removal of this defensive process without quieting the internal commotion can have deleterious effects. When one or both members of a marriage desire children, the identification of one as infertile puts a significant stress on the relationship. Interpersonal and intrapsychic turmoil results, which may require professional help to quiet. The treatment of psychophysiologic infertility should include identifying specific areas of conflict and then attempting to modify responses, attitudes, and affects that cause or intensify the conflicts. Through a learning experience, anxious and insecure patients can be helped to tolerate the anticipation of pregnancy and parenthood. Even those who do not achieve pregnancy can be helped to maintain their feelings of self-worth and self-esteem.

Anxiety Disorders↗
PubMedDate not supplied

Pituitary gonadal function in infertile men with varicocele.

Infertile men with varicocele or idiopathic infertility were compared with a control group. Spermocytograms were taken and the following radioimmunological plasma analyses carried out: testosterone, FSH and LH before and after 50 micrograms LRH, Prolactin (PRL) before and after 200 micrograms TRH; in addition, 8 patients with varicoceles and 3 controls received LRH intravenously (0.4 microgram/min.) for 4 hours. The binding of [125I] human chorionic gonadotrophin (hCG) to testicular tissue obtained by biopsy from 10 infertile men was also investigated. Of the parameters studied, no differences were found between the unilateral or bilateral varicoceles. In the two groups of infertile men, sperm motility and percentage normal forms were similar and significantly lower than in controls. As compared to the controls, in the groups of infertile men, basal LH and testosterone levels were no different but basal FSH levels was increased, basal PRL was higher (p less than 0.05) in the varicocele group. Responses of the LH, FSH and PRL to LRH and TRH stimulations were generally higher in infertile men than in controls. As compared to the idiopathic infertile men, testosterone levels and responses of plasma FSH to LRH injection were lower in varicocele group. Moreover, in infertile men with varicocele, age was correlated negatively with sperm motility and testosterone level and it was correlated positively with LH response to LRH injection. For each patient, testicular tissue was able to specifically bind [125I]hCG, but in some cases of varicoceles, hCG binding capacity was different in the two testes and seemed higher than that observed in men with obstructive azoospermia. These results suggest: 1) dysfunction in both spermatogenesis and Leydig cells with a compensatory hyperfunction of the pituitary gland in infertile men with varicocele; 2) worsening in Leydig cells and tubular lesions with longer duration of varicocele; and 3) absence of any gross abnormality in hCG binding to its specific receptors in the testis of men with varicocele. These data suggest varicoceles may play a causal role in infertility.

Adult↗
PubMed1995

Lower genital tract infections in infertile Nigerian women compared with controls.

OBJECTIVE: To investigate the possibility that infertile Nigerian women have a higher rate of cervical colonisation with pathogenic and facultative organisms than fertile controls. DESIGN: The prevalence of common microorganisms in the vagina and endocervical canals of infertile women was compared with that of pregnant controls. SETTING: The Obafemi Awolowo University Hospital Maternity Centre. SUBJECTS: 92 infertile women were compared with 86 pregnant controls. MAIN OUTCOME MEASURES: rates of isolation of Neisseria gonorrhoeae, Candida albicans, Trichomonas vaginalis and other facultative organisms in cases and controls. RESULTS: The rate of isolation of Neisseria gonorrheae was 17.4% among infertile women compared with 10.5% in the group of pregnant women (p > 0.05). There was no significant difference between the groups in the rate of isolation of Candida albicans, Trichomonas vaginalis and other facultative organisms. High rates of isolation of microorganisms were observed in both groups. However, women with secondary infertility had higher rate of carriage of Neisseria gonorrheae, Candida albicans and Staphylococcus aureus as compared with women with primary infertility. Nearly 15% of infertile women had previous episodes of pelvic inflammatory disease and 26% had had induced abortions. A positive history of vaginal discharge was a poor predictor of vagina and endocervical carriage of microorganisms. CONCLUSIONS: High rates of pathogenic organisms exist in the lower genital tract of infertile women and controls. Women with secondary infertility are more likely to have pathogenic organisms than women with primary infertility. A policy of routinely screening women for lower genital tract infections should be pursued in this population because of the high rate of infection.

Adolescent↗
PubMed1984

The dark mink: a model of male infertility.

Breeding mink for a fine dark fur has coselected male infertility, which may be manifest at the onset of breeding (primary infertility) or after one or more fertile breeding seasons (secondary infertility). Mink with primary infertility have low LH and testosterone levels. However, they respond to exogenous GnRH with increases in LH production and in the number and size of LH and FSH positive gonadotropes in the anterior pituitary. Exogenous human CG also induces testosterone secretion. Thus, mink with primary infertility are probably defective in GnRH secretion, which is due either to abnormal hypothalamic function or its control mechanisms. Autoimmune orchitis with testicular immune complexes are frequent in mink with secondary infertility, suggesting an autoimmune etiology. In contrast, fertile dark mink and fertile mink with the opaline and pastel fur have normal serum LH and testosterone levels; their testes are also normal. In mink with secondary infertility, the frequency and degree of orchitis and testicular immune complexes increased from March (peak sexual activity) to April (onset of testicular regression). Thus, testicular autoimmunity most likely develops during testicular regression. Antisperm antibodies also increased in frequency during testicular regression in the fertile dark mink and in dark mink with primary and secondary infertility. Thus, antisperm antibody per se is insufficient to induce autoimmune orchitis. It is concluded that the infertile mink is a useful model of human male infertility, involving both endocrinological and immunological mechanisms.

Animals↗
PubMed1997

Infertility in an industrial setting--a population-based study from Northern Sweden.

OBJECTIVE: To analyze the possible environmental effects on infertility among couples living in the immediate neighborhood of a smelter and to study prevalence and risk factors of infertility as well as care seeking behavior among infertile couples in a random sample of a local population. METHODS: A questionnaire was distributed to 1,784 women between 25 and 44 years of age working at or living close to a copper smelter, and to women living further away from the smelter. The results were analyzed with a logistic regression. RESULTS: No environmental effects on infertility rates among couples living near the smelter were found. The prevalence of infertility, defined as having experienced a period of inability to conceive within 12 months of regular intercourse without contraception at some point in life, was the same between the neighbors and the reference population. The prevalence of primary and secondary infertility was 6% and 3%, respectively. Infertile women were characterized by having a significantly shorter education, OR 1.8 (CI 1.2-2.7), compared to women who had not experienced any fertility problems. Risk estimates for not seeking health care when having a low socio-economic status was OR 2.1 (CI 1.0-4.4) compared to those with a higher socio-economic status. CONCLUSION: No environmental effects on infertility could be demonstrated. Infertile women were characterized by having a shorter education compared to the non infertile, and women with lower socio-economic status were less prone to seek help.

Adult↗
PubMedDate not supplied

Tubal abnormalities on hysterosalpingography in primary and secondary infertility.

BACKGROUND: Hysterosalpingography (HSG) is an imaging modality used in assessing the fallopian tubes of patients with infertility. There have been reports suggesting that tubal pathologies may be responsible for most cases of secondary infertility. OBJECTIVE: To evaluate the fallopian tube of women with infertility and to observe if there are significant differences in the tubal findings in primary and secondary infertility. METHODOLOGY: One hundred and twenty (120) patients attending the outpatient fertility clinics in University of Ilorin Teaching Hospital, (UITH) Nigeria were studied; Twenty-four (20%) presented with primary infertility and Ninety-six (80%) with secondary infertility. All the patients had HSG. RESULTS: A total of 48(40%) patients out of the 120 studied had a tubal pathology, out of which 43 (44.8%) had secondary infertility and 5(20.8%) had primary infertility. Tubal pathology was found to be significantly associated with secondary infertility than primary infertility (P< 0.05, Odds ratio = 3, CI = 95%).

Adult↗
PubMed2000

Knowledge of and attitudes towards infertility held by members of two county councils in Sweden.

BACKGROUND: To investigate Swedish county council members knowledge of the laws regulating infertility treatment, their understanding of the suggestions put forward in the report 'Priorities in Health Care' and their attitudes towards infertility. METHODS: All members (n=182) of the 1998 county councils of Linköping and Jönköping were asked to participate in the study. In total, 153 answered the questionnaire. RESULTS: Different age groups did not show different levels of knowledge. Similarly, there was no significant difference between men and women concerning their knowledge of infertility laws. Furthermore, those committee members who were very positive towards infertility treatment did not have any better knowledge of such treatment than those who were less positive. The men and women who themselves had previously had or were dealing with infertility problems at the time of the survey (12 per cent) displayed the same level of knowledge as the other council members. They also expressed similar attitudes. The members showed very little familiarity with the priority groups suggested in the report from the Health Care Priority Committee. For example, only 18 per cent knew that this committee in priority group III placed infertility treatment and investigation. 31.3 per cent answered that infertility was placed in group V, a group that does not exist. The majority stated that they had a positive attitude towards the treatment of infertility. This is indicated, for example, by their rejection of the statement 'it's [infertility is] a luxury problem'. CONCLUSIONS: The relative lack of knowledge of Swedish law and of the report from the Health Care Priority Committee might lead to a lower level of commitment to dealing with the problems that infertile couples face than if the members were better informed. In other words, this lack of knowledge might influence the decisions of the county council members.

Adult↗
PubMed2005

Tubal abnormalities in Thai infertile females.

OBJECTIVE: To determine the prevalence of tubal abnormalities among infertile patients attending the clinic at Srinagarind Hospital. DESIGN: A descriptive study SETTING: Infertility clinic, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. SUBJECT: A total of 740 female patients presented at the infertility clinic, Srinagarind Hospital between 1 January 1998 and 31 December 2002. MATERIAL AND METHOD: A retrospective review of demographic data, baseline infertility information and the results of tubal assesments (including both hysterosalpingography and laparoscopy) were conducted. MAIN OUTCOME MEASURE: Prevalence of tubal abnormalities in infertile females being treated in the infertility clinic during the study period. RESULTS: Among the 740 patients being recruited to the present study, 533 cases (72.03%) were diagnosed with primary infertility while the rest (207 or 27.97%) came to the clinic due to secondary infertility. The mean infertile period of all study subjects was 4.68 years. Regarding the methods used for tubal assessments, hysterosalpingography (HSG), laparoscopy and combination of the two methods were conducted in 556 cases (75.14%), 30 cases (4.05%) and 154 cases (20.81%), respectively. The prevalence of tubal abnormalities demonstrated in the present study was 27.30% (202 from 740 cases). Among the 202 patients with tubal abnormalities, the pathologies detected were cornual occlusion (46.04%), combined tubal abnormalities (30.20%), distal tubal occlusion (8.42%), hydrosalpinx (3.47%), peritubal adhesion (3.96%), and other abnormalities (7.91%). Other pelvic pathologies detected from laparoscopy were endometriosis (61.49%), pelvic adhesion (24.22%), leiomyoma (12.42%), and ovarian cyst (1.87%). CONCLUSION: Tubal abnormalities were detected in over one-fourth of all infertile females being treated at Srinagarind Hospital. Further study investigating the etiologies of these abnormalities is needed since it could be the measure to bring down the occurrence of such conditions.

Adult↗
PubMed1997

Socio-biological status of Nigerian males with primary and secondary infertility.

Husbands in 100 consecutive couples complaining of lack of pregnancy after one year of normal intercourse were engaged in this study. Information from a structured questionnaire administered to these 100 men showed that 46% had primary infertility (had never impregnated any woman) and 54% secondary infertility (had in the past impregnated at least one woman irrespective of the outcome of the pregnancy). The mean ages (years) and standard error of mean for the primary and secondary infertile groups were 33.46 +/- 1.45 and 39.28 +/- 1.41 respectively. The difference was statistically significant (p < 0.05). Semen culture for growth of bacteria was positive in 59.3% of subjects with secondary infertility as opposed to 40.7% for primary infertility. The difference was, again, statistically significant (p < 0.05). These findings indicate that a higher proportion of husbands in infertile couples in a group of this environment had secondary infertility, were older and were more likely to harbour infections in their semen than those with primary infertility. Hence there should be a greater awareness of the significant involvement of bacterial infection of the genital tract of infertile Nigerian subjects than and before this factor should be taken into account in the prevention and treatment strategies for infertility in this and presumably other tropical countries.

Adult↗
PubMed2004

A survey of relationship between anxiety, depression and duration of infertility.

BACKGROUND: A cross sectional study was designed to survey the relationship between anxiety/depression and duration/cause of infertility, in Vali-e-Asr Reproductive Health Research Center, Tehran, Iran. METHODS: After obtaining their consents, 370 female patients with different infertility causes participated in, and data gathered by Beck Depression Inventory(BDI) and Cattle questionnaires for surveying anxiety and depression due to the duration of infertility. This was studied in relation to patients' age, educational level, socio-economic status and job (patients and their husbands). RESULTS: Age range was 17-45 years and duration and cause of infertility was 1-20 years. This survey showed that 151 women (40.8%) had depression and 321 women (86.8%) had anxiety. Depression had a significant relation with cause of infertility, duration of infertility, educational level, and job of women. Anxiety had a significant relationship with duration of infertility and educational level, but not with cause of infertility, or job. Findings showed that anxiety and depression were most common after 4-6 years of infertility and especially severe depression could be found in those who had infertility for 7-9 years. CONCLUSIONS: Adequate attention to these patients psychologically and treating them properly, is of great importance for their mental health and will improve quality of their lives.

Journal Article↗
PubMed2003

Infertility rates following POMB/ACE chemotherapy for male and female germ cell tumours - a retrospective long-term follow-up study.

The risk of chemotherapy-induced infertility in male and female germ cell tumour (GCT) survivors is unclear, but may correlate with cisplatin dose. Here, we examine a large series of GCT patients for the effect of chemotherapy on those attempting to have children. Our GCT database was screened for nonseminomatous GCT patients who had (1). received POMB/ACE chemotherapy (cisplatin, vincristine, methotrexate, bleomycin alternating with actinomycin D, cyclophosphamide and etoposide) and (2). stage I male GCT patients who were untreated between 1977 and 1996. Fertility was assessed by questionnaire and medical records. A total of 64 of 153 treated and 35 of 115 untreated men attempted to have children. In all, 28% (18 out of 64) receiving POMB/ACE were unsuccessful. Radiotherapy (six), atrophic remaining testis (one) or prior infertility (three) were implicated in 10 cases, so chemotherapy-induced infertility may have occurred in only 11% (eight out of 64). Strikingly, 26% (nine out of 35) of untreated stage I patients also failed to have children (three had radiotherapy, three prior infertility). Moreover, in treated men, no association was seen between cisplatin dose and infertility. In contrast, radiotherapy significantly increased male infertility (P=0.001). Of 28 treated women who attempted to have children, 25% (seven out of 28) were unsuccessful. One previously had infertility and one subsequently had successful IVF so chemotherapy-induced infertility potentially occurred in only 18% (five out of 28) and was not related to cisplatin dose. In conclusion, the risk of chemotherapy-induced infertility is low in both male and female GCT patients and does not clearly correlate with the cumulative cisplatin dose.

Adult↗
PubMed2001

Natural cycle IVF in unexplained, endometriosis-associated and tubal factor infertility.

BACKGROUND: To elucidate possible differences between unexplained and minimal peritoneal endometriosis-associated infertility, we studied their outcome in natural cycle IVF (NIVF). METHODS: A prospective cohort study was carried out on unexplained (33 couples), minimal peritoneal endometriosis-associated (30 couples) and tubal factor (24 couples) infertility in 223 NIVF cycles, using human chorionic gonadotrophin (HCG) for ovulation induction. RESULTS: During the first NIVF attempt, follicular and luteal phase oestradiol, FSH, LH and progesterone concentrations, as well as endometrial thickness and follicular diameter were similar among the three groups. Periovulatory follicular growth monitored from day of HCG administration to oocyte aspiration was significantly lowered in unexplained infertility compared with minimal endometriosis-associated and tubal factor infertility. The fertilization rate, clinical pregnancy rate per initiated cycle, per successful oocyte retrieval and per embryo transfer, in minimal endometriosis (80.0, 10.4, 16.0 and 23.5% respectively) were similar to that in tubal factor infertility patients (68.6, 5.8, 11.4 and 16.0%) but significantly higher (P < 0.05) than that of the unexplained infertility group (62.2, 2.6, 5.4 and 8.7%). CONCLUSIONS: The significant reduction in follicular periovulatory growth, fertilization and pregnancy rates in unexplained infertility compared with minimal peritoneal endometriosis patients may be explained by sub-optimal follicular development with possibly reduced oocyte quality, intrinsic embryo quality factors or by impaired implantation. From a clinical point of view, NIVF is less suited to unexplained infertility treatment, but might represent an interesting treatment option for minimal peritoneal endometriosis-associated infertility.

Adult↗
PubMed2004

'You are a man because you have children': experiences, reproductive health knowledge and treatment-seeking behaviour among men suffering from couple infertility in South Africa.

BACKGROUND: In Africa, infertility traditionally has been viewed as a female problem. This study explores reproductive health knowledge, health-seeking behaviour and experiences related to involuntary childlessness in men suffering from couple infertility. METHODS: Twenty-seven men from a diverse cultural urban community in South Africa participated in in-depth interviews at the time of their first visit to an infertility clinic in a tertiary referral centre. RESULTS: Men had little knowledge about the physiology of human fertility, causes of infertility and modern treatment options. Awareness of male factor infertility was, however, high. Most men appeared involved in the health-seeking process. Men described their emotional reactions to childlessness and the impact of infertility on marital stability, and many reported that infertile men suffered from stigmatization, verbal abuse and loss of social status. CONCLUSIONS: These findings improve our understanding of the reproductive health needs of men suffering from couple infertility in Africa. This understanding is essential for the effective integration of male partners into modern infertility management. The need for appropriate counselling of men and, most particularly, for education of the community is recognized.

Community-Institutional Relations↗
PubMed2005

Definition and prevalence of subfertility and infertility.

A common definition of sub- and infertility is very important for the appropriate management of infertility. Subfertility generally describes any form of reduced fertility with prolonged time of unwanted non-conception. Infertility may be used synonymously with sterility with only sporadically occurring spontaneous pregnancies. The major factor affecting the individual spontaneous pregnancy prospect is the time of unwanted non-conception which determines the grading of subfertility. Most of the pregnancies occur in the first six cycles with intercourse in the fertile phase (80%). After that, serious subfertility must be assumed in every second couple (10%) although--after 12 unsuccessful cycles--untreated live birth rates among them will reach nearly 55% in the next 36 months. Thereafter (48 months), approximately 5% of the couples are definitive infertile with a nearly zero chance of becoming spontaneously pregnant in the future. With age, cumulative probabilities of conception decline because heterogeneity in fecundity increases due to a higher proportion of infertile couples. In truly fertile couples cumulative probabilities of conception are probably age independent. Under appropriate circumstances a basic infertility work-up after six unsuccessful cycles with fertility-focused intercourse will identify couples with significant infertility problems to avoid both infertility under- and over-treatment, regardless of age: Couples with a reasonably good prognosis (e.g. unexplained infertility) may be encouraged to wait because even with treatment they do not have a better chance of conceiving. The others may benefit from an early resort to assisted reproduction treatment.

Age Factors↗