Definition and prevalence of subfertility and infertility.
A common definition of sub- and infertility is very important for the appropriate management of infertility. Subfertility generally describes any form of reduced fertility with prolonged time of unwanted non-conception. Infertility may be used synonymously with sterility with only sporadically occurring spontaneous pregnancies. The major factor affecting the individual spontaneous pregnancy prospect is the time of unwanted non-conception which determines the grading of subfertility. Most of the pregnancies occur in the first six cycles with intercourse in the fertile phase (80%). After that, serious subfertility must be assumed in every second couple (10%) although--after 12 unsuccessful cycles--untreated live birth rates among them will reach nearly 55% in the next 36 months. Thereafter (48 months), approximately 5% of the couples are definitive infertile with a nearly zero chance of becoming spontaneously pregnant in the future. With age, cumulative probabilities of conception decline because heterogeneity in fecundity increases due to a higher proportion of infertile couples. In truly fertile couples cumulative probabilities of conception are probably age independent. Under appropriate circumstances a basic infertility work-up after six unsuccessful cycles with fertility-focused intercourse will identify couples with significant infertility problems to avoid both infertility under- and over-treatment, regardless of age: Couples with a reasonably good prognosis (e.g. unexplained infertility) may be encouraged to wait because even with treatment they do not have a better chance of conceiving. The others may benefit from an early resort to assisted reproduction treatment.
Gnoth
C
C
Center for Family Planning, Gynaecological Endocrinology & Reproductive Medicine Grevenbroich, Heinrich-Heine University of Duesseldorf, Germany. gnoth@uni-duesseldorf.de
Godehardt
E
E
Frank-Herrmann
P
P
Friol
K
K
Tigges
Jürgen
J
Freundl
G
G
D000367:Age Factors; D001723:Birth Rate; D005260:Female; D006801:Humans; D007246:Infertility / Q000453:epidemiology* / Q000209:etiology*; D007247:Infertility, Female / Q000453:epidemiology; D008297:Male; D011247:Pregnancy; D015995:Prevalence