Comprehensive preventive health care in female-factor infertility: issues, problems and proposals

Abstract

Presently available information on the causation and management of infertility disorders is sufficient for the formulation of some tentative proposals for the provision of preventive reproductive health care to females. This should be aimed at preventing the initiation of the infertility-associated disorder in the first place (primary prevention), at detecting and preventing overt manifestations of disease (secondary prevention) and/or halting or slowing disease progression, and at reducing long-term morbidity and preventing mortality (tertiary prevention). This review will suggest ways to implement such preventive strategies with respect to the care of women with endometriosis, polycystic ovary syndrome, tubal pathology, and hypoestrogenism. We will also discuss the prevention of iatrogenic problems encountered during infertility management such as multiple pregnancy, ovarian hyperstimulation syndrome, postoperative pelvic adhesions, and delayed referral for subspecialist care. These primary care issues should be considered by all physicians who care for females from infancy, through adolescence, to the reproductive and postreproductive age periods. We hope that dialogue and future developments will lead to further refinement of our present proposals.