Infertility affects approximately 15% of reproductive-ageI couples in the United States.Reproductive agegen-erally encompasses ages 15 to 44 years, although pregnancy can occur outside of this age range. Infertilityis the failure of a couple to conceive after 12 months of frequent, unprotected intercourse. The probability of achieving a preg-nancy in one menstrual cycle is termed fecundability, and is estimated to be 20% to 25% in healthy young couples. Similarly, fecundity is the probability of achieving a live birth in one menstrual cycle. Fecundability and fecundity both decrease over time; in other words, the probability of conceiving in a given menstrual cycle decreases as the dura-tion of time to achieve conception increases (Fig. 38.1). After 12 months without using contraception, approximately 50% of couples will conceive spontaneously within the following 36 months. If a couple does not conceive by this point, then infertility will likely persist without medical intervention. Infertility is a condition that encompasses a wide spec-trum of reversible and irreversible disorders, and many suc-cessful treatments are available. Today, greater numbers of men and women are seeking infertility treatment due to increased public awareness of infertility and available treat-ments, improvements in the availability and range of fertility treatments, improvements in physicians’ ability to evaluate and diagnose infertility, and changes in social acceptance of infertility. Furthermore, many individuals and same-sex couples as well seek fertility treatments to con-ceive.
Today, 85% of infertile couples who undergo appropriate treatment can expect to have a child. However, fertility treat-ment can be a difficult experience for an individual or a couple. The inability to conceive or carry a pregnancy can be emotionally stressful, and fertility treatment can be a significant financial burden. The psychologic stress associated with infertility must be recognized and patients should be coun-seled accordingly.
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