Women who fail to achieve a successful pregnancy after 12 months of regular, unprotected intercourse should be evaluated with the diagnosis of infertility. Evaluation should be initiated after 6 months for women >35 years. If over 40 years of age, or a condition known to cause infertility is present, evaluation should not be delayed.
Evaluation of women for infertility should be timely, cost effective, and initially focused on the most common causes of infertility such as ovulatory dysfunction. If ovulatory function is normal, uterine anatomy and tubal patency should be investigated. Tests for ovarian reserve can not predict failure to conceive and therefore should not be used to deny fertility treatment. Ovarian reserve testing should not be used to predict the likelihood of spontaneous conception or menopause.
Indications for Immediate Evaluation Include
Definition of Unexplained Infertility (30% of infertile couples)
Ovulatory Function
Ovarian Reserve
ASRM: Fertility evaluation of infertile women: a committee opinion
ACOG and ASRM Committee Opinion 781: Infertility Workup for the Women’s Health Specialist
ACOG Committee Opinion 773: The Use of Antimüllerian Hormone in Women Not Seeking Fertility Care
The AHRQ released a systematic review with the goal of evaluating the comparative effectiveness and safety of treatments for common causes of infertility. Previous studies often did not separate outcomes based on diagnoses. This systematic review focuses on the following clinical scenarios
PCOS
Couples with unexplained infertility
Couples with Male factor infertility
Oocyte donors
In general, our current review’s findings are consistent with the NICE and ASRM guidelines— there is a general consensus that the overall body of evidence for many aspects of infertility treatment across all patient groups is limited. One consistent limitation is the relative paucity of studies utilizing live birth per couple as the primary outcome
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