Introduction

This chapter discusses the prevalence of infertility and the importance of the initial assessment of the infertile couple. Efficient mechanisms for referral and investigation and adoption of region-wide protocols of basic investigation are requirements for those involved in the planning of services, and should be founded upon good liaison between medical and nursing staff in both primary and secondary care. Adherence to such protocols facilitates appropriate and timely investigation along standardised paths, minimising the risks of delay and repetition of tests, which couples find particularly demoralising. Once a diagnosis is reached, it should be possible to offer the infertile couple an accurate prognosis and the opportunity to consider the issues relevant to treatment choices for their particular situation.

Epidemiology

A common definition of infertility is the inability of a couple to conceive following 12–24 months of exposure to pregnancy. The length of exposure time considered is determined by the observation that in the general population, which would include a proportion of couples with infertility, one would expect the chance of conception in any individual cycle to be around 20%. Thus by 1 year of exposure about 85% of couples would have achieved conception and by the time 2 years has elapsed some 92% would have conceived. In practical terms, the failure to achieve pregnancy causes enormous distress to those affected. For people with fertility problems, using a definition of 1 year to describe infertility is usual and most will have sought medical advice or assistance by that time.