Infertility is a common problem in the United States, occurring in approximately 15% of couples.

The World Health Organization (WHO) task force on Diagnosis and Treatment of Infertility described the frequency of conditions contributing to infertility in developed countries as follows.1 Female infertility (37%), male infertility (38%), ovulatory disorders (25%), hyperprolactinemia (7%), pelvic adhesions (12%), tubal occlusion (11%), endometriosis (15%), and many others. Infertility factors can be broadly grouped into seven major categories that influence fecundability.

The basic workup for infertility should begin 1 year after discontinuance of contraception. The workup includes a semen analysis, documentation of ovulation, and uterine/tubal evaluation with a hysterosalpingogram or sono-hysterosalpingogram.

A thorough history and physical examination of both the man and woman may identify the etiology of infertility and direct further testing to the most likely cause of infertility.

Treatment for male factor infertility includes surgery, IUI, and IVF with intracytoplasmic sperm injection (ICSI) with either epididymal or testicular sperm extraction. Despite severe oligoasthenospermia or azoospermia these techniques allow couples to conceive. When all treatments with husbands are doom to fail donor insemination can be considered.

Treatment of hypothalamic dysfunction includes the GnRH pump and injectable gonadotropins. Hyperprolactinemia is successfully treated with dopamine agonists. Polycystic ovarian syndrome can be treated with clomiphene citrate, surgery, injectable gonadotropins, and insulin-sensitizing medications. Premature ovarian failure can be treated with donor oocytes.

Uterine and tubal factor infertility may be treated surgically. Severe tubal factor infertility is most successfully treated with IVF.

Unexplained infertility can be treated with clomiphene citrate/intrauterine insemination, injectable gonadotropin/intrauterine insemination, or IVF. Women with advanced maternal age are best served by rapid workup and treatment.