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Infertility is the inability to achieve a pregnancy after 12 months of regular, unprotected sexual intercourse; more broadly, infertility describes the impairment of a person's capacity to reproduce as an individual or with their partner. 1 Infertility affects between 8% and 12% of couples of reproductive age worldwide, with some variation based on geographic location. 2 In the United States, 12.2% of females 15 to 49 years of age have received infertility services. 3
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| Infertility evaluation should begin after 12 months of regular, unprotected intercourse in a female younger than 35 years, after six months between 35 and 40 years of age, or immediately if older than 40 years or if the patient has risk factors for infertility. 1,9,10,12 | C | Expert opinion and consensus guidelines |
| Evaluation of infertility should include semen analysis, history and physical examination focusing on menstrual history, past infection, sexual dysfunction, surgical history, and medication use. 9 | C | Expert opinion and consensus guidelines |
| Clomiphene or letrozole with intrauterine insemination should be used as first-line therapy for unexplained infertility. 17,28 | A | Guidelines with grading based on consistent evidence from randomized controlled trials showing improved live birth rates compared with expectant management |
| All women who are obese should be counseled on lifestyle modifications and weight loss to improve spontaneous ovulation and response to ovulation induction. 23 | C | Expert opinion |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
Primary infertility is having never achieved a pregnancy. Secondary infertility is the inability to achieve a pregnancy after a previous pregnancy. Both contribute significantly to infertility worldwide. 2
This article focuses on infertility in opposite-sex partners; however, same-sex couples and others in nonheterosexual partnerships also require evaluation and management of fertility issues. For this review, female and male refer to the sex assigned at birth.
Epidemiology
Globally, 48 million couples and 186 million individuals are affected by infertility. 4 The National Survey of Family Growth shows that 19.4% of currently married women in the United States who are 15 to 49 years of age have had zero births...