Endocrine Abstracts

Infertility is defined by the World Health Organization (WHO) as the inability of a couple to achieve conception or bring a pregnancy to term after 1 year or more of regular, unprotected sexual intercourse. It remains a major clinical and social problem, affecting 13–15% of couples worldwide. Evaluation usually starts after 12 months, although it might be indicated earlier. The most common causes of infertility are divided into: male factor, related to sperm abnormalities, female factor, such as ovulatory dysfunction and tubal pathology, combined male and female factor or unexplained infertility, where no obvious cause is found. We reviewed randomized studies, meta-analyses and scientific societies recommendations to propose a simplified approach for the management of the infertile couple.

Full history-taking (obstetric, developmental, menstrual, contraceptive, sexual, familial, past/present history) is a necessary tool to identify most of underlying problem.

To exclude male and/or female factor, clinical examination, semen analysis (with the WHO reference values), detection of testicular function (hormonal assay, scrotal ultrasonography), ovarian function (early follicular FSH and LH levels, mid-luteal progesterone, transvaginal ultrasonography), and evaluation of tubal patency by hysterosalpingography should be performed. Chromosomal karyotyping and genetic screening are indicated in selected cases (suspected genetic disorders, sex chromosomal aneuploidy, cystic fibrosis, deletion of Y-chromosome).

The therapeutic strategies can be classified as etiological or empirical, whether or not a causative factor is found; fertility treatments are classified into: medical (including hormones for ovulation/spermatogenesis induction, nutraceutical supplementation); surgical (such as hysteroscopy, varicocelectomy and treatment of obstructive disorders); assisted reproduction techniques (ART). The need for ART, however, should not preclude the search for etiological treatments, any surgical or medical therapy appropriate for improving the fertility potential. Finally, the approach to diagnosis and management of infertility should be balanced taking into account several aspects that include efficacy, timing, costs, compliance and side effects.

Declaration of interest: The author declares that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.