Diagnosis and Management of Infertility: A Review.
Level 5 - mechanism / opinion, no new human data
Narrative clinical review without systematic review methodology reported in the abstract.
PubMed 34228062 · doi:10.1001/jama.2021.4788
What was done
This narrative review summarizes clinical evidence regarding the definition, etiology, diagnostic evaluation, and treatment strategies for couples presenting with infertility.
What was found
Infertility affects approximately 12.7% (1 in 8) of reproductive-age women seeking treatment annually in the United States. An identifiable cause is present in approximately 85% of couples, led by ovulatory dysfunction (25% of cases; 70% of which are due to polycystic ovary syndrome), male factor infertility, and tubal disease, leaving 15% with unexplained infertility. Medical management includes clomiphene citrate, letrozole, and gonadotropins; gonadotropin use carries risks of multiple pregnancy (up to 36% of cycles) and ovarian hyperstimulation syndrome (1% to 5% of cycles). Initial treatment includes timed intercourse with ovulation induction for anovulation, and 3 to 4 cycles of ovarian stimulation for unexplained infertility, endometriosis, or mild male factor. Direct or early in vitro fertilization (IVF) is indicated for severe male factor, bilateral tubal obstruction, or women aged 38 to 40 years and older.
Why it matters
It provides a structured clinical algorithm for primary care clinicians and specialists to diagnose infertility causes and determine appropriate triage between ovulation induction, ovarian stimulation, and direct IVF.
Limits
The abstract describes a broad narrative overview without systematic search criteria, meta-analytic pooling, or sample size reporting. Quantitative success rates, comparative live-birth odds between distinct protocols, and long-term neonatal outcomes are not provided in the abstract text.
Cited by
- supports Polycystic ovary syndrome (PCOS) and endometriosis are the leading causes of female infertility worldwide.
- context Endometriosis is the leading cause of chronic pelvic pain and the leading cause of infertility in women.