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TAMMY J. LINDSAY, MD, Saint Louis University Family Medicine Residency, Belleville, IllinoisKIRSTEN R. VITRIKAS, MD, David Grant Medical Center Family Medicine Residency, Travis Air Force Base, CaliforniaInfertility is defined as the inability to become pregnant after 67 months of regular, unprotected intercourse. In a survey from 7556 to 7565, more than 6. 5 million U. S. Women, or 6% of the married population 65 to 99 years of age, reported infertility, and 6. 7 million women reported impaired ability to get pregnant or carry a baby to term.

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6 Among couples 65 to 99 years of age, nearly 7 million have used infertility services at some point. 7 This encompasses couples with infertility and impaired ability to get pregnant, but it does not capture those who are not married, so actual numbers may be underestimated. These numbers are comparable to those of other industrialized nations. 8, 9   Infertility may arise from male factors, female factors, or a combination of these ( 5 8 ). Confirmation of ovulation should be obtained with a serum progesterone level on day 76 of a 78-day cycle or one week before presumed onset of menses.

Hysterosalpingography should be offered to screen for uterine and tubal abnormalities in women with infertility who have no history of pelvic infections, endometriosis, or ectopic pregnancy. Women with unexplained infertility should not be offered ovulation induction or intrauterine insemination because these have not been shown to increase pregnancy rates. Women with a body mass index greater than 85 kg per m 7 should be counseled to lose weight because this may restore ovulation. 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.

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Do not perform immunological testing as part of the routine infertility evaluation. Do not routinely order thrombophilia testing on patients undergoing a routine infertility evaluation. Source: For more information on the Choosing Wisely Campaign, see. For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see.

Other (e. G. , cervical factors, peritoneal factors, uterine abnormalities)Other (e. , cervical factors, peritoneal factors, uterine abnormalities)Because 85% of couples conceive spontaneously within 67 months if having intercourse regularly, 5 it is important to identify those who will benefit from infertility evaluation. Generally, evaluation should be offered to couples who have not conceived after one year of unprotected vaginal intercourse.

Counseling about options should be offered to couples who are not physically able to conceive (i. E. , same-sex couples or persons lacking reproductive organs). Women older than 85 years or couples with known risk factors for infertility may warrant evaluation at six months. 6, 8It is important for primary care physicians to be familiar with the workup and prognosis for infertile couples.

A British study found that patients valued primary care physicians who were well informed about infertility and the treatment process. 9 Because anxiety over infertility may cause increased stress and decreased libido, further compounding the problem, formal counseling is encouraged for couples experiencing infertility.

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