title: Infertility evaluation and management. Strategies for family physicians.
abstract: OBJECTIVE
  To review family physicians' role in investigation and management of infertile couples.
  
  
  METHODS
  MEDLINE and PubMed were searched using the MeSH headings infertility, advanced maternal age, polycystic ovarian syndrome, clomiphene citrate, and insulin sensitizers. Bibliographies of review articles and textbooks were also searched. Review articles, randomized trials, observational studies, and case series are cited.
  
  
  RESULTS
  Approximately 8% of Canadian couples have difficulty conceiving. Mother's age significantly affects ability to conceive. Infertility assessment focuses on ovulatory dysfunction, tubal factors, sexual factors, and male factors. Women older than 35 years more than 12 months infertile; women younger than 35 more than 18 months infertile; women likely to have such problems as anovulation, tubal disease, or endometriosis; women whose partners' semen tests abnormal; and women who request referral should be referred. Patients treated with clomiphene citrate should be aware of its potential side effects.
  
  
  CONCLUSIONS
  Family physicians have an important role in preconception counseling. Detailed and focused assessment facilitates initial investigations and treatment and can identify couples who could benefit from referral for further assessment.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Royal University Hospital, University of Saskatchewan, Saskatoon. Allison.Case@usask.ca
authors.forename: Allison M
authors.initials: AM
authors.lastname: Case
mesh_terms: D000328:Adult; D000367:Age Factors; D002170:Canada; D002996:Clomiphene / Q000009:adverse effects / Q000627:therapeutic use; D003376:Counseling; D005260:Female; D005300:Fertility Agents, Female / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D007246:Infertility / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D010821:Physicians, Family
chemical_list: D005300:Fertility Agents, Female; D002996:Clomiphene