Evidence-based infertility: evaluation of the female partner

Abstract

Infertility, involving at least 1 year of attempted conception without success, affects 10,000 couples per million populations. Evaluation of a couple is generally indicated after a year, by which time most normal couples attempting conception would have been successful. The principles of evidence-based medicine indicate that the diagnostic tests should correlate with the outcome of interest to couples, that is live birth. In the female partner, these tests are assessment of ovulation by cycle history or mid-luteal progesterone and of tubal pathology by Chlamydia antibody testing, tubal patency tests or laparoscopy. The chief female categories of infertility are ovulation disorders (25%), tubal disease (15%) and endometriosis (10%). Male infertility is the primary diagnosis in approximately 25% of cases and contributes to a further 15% to 25% of the remaining cases. The infertility remains unexplained in at least 20% of cases because numerous reproductive defects are undetectable with current methods. Undetectable deficiencies in oocyte or sperm quality and tubal function may contribute to fertilization failure and diminished embryo quality. Even high quality embryos may undergo implantation failure by means that are poorly understood. Research is needed to improve awareness of potential fertility defects before and after fertilization and possible errors in embryonic development.