Skip to main content
Top
Published in: Reproductive Biology and Endocrinology 1/2010

Open Access 01-12-2010 | Methodology

Management of the infertile couple: an evidence-based protocol

Author: Remah M Kamel

Published in: Reproductive Biology and Endocrinology | Issue 1/2010

Login to get access

Abstract

Background

Infertility is defined as inability of a couple to conceive naturally after one year of regular unprotected sexual intercourse. It remains a major clinical and social problem, affecting perhaps one couple in six. Evaluation usually starts after 12 months; however it may be indicated earlier. The most common causes of infertility are: male factor such as sperm abnormalities, female factor such as ovulation dysfunction and tubal pathology, combined male and female factors and unexplained infertility.

Objectives

The aim of this study is to provide the healthcare professionals an evidence-based management protocol for infertile couples away from medical information overload.

Methods

A comprehensive review where the literature was searched for "Management of infertility and/or infertile couples" at library website of University of Bristol (MetaLib) by using a cross-search of different medical databases besides the relevant printed medical journals and periodicals. Guidelines and recommendations were retrieved from the best evidence reviews such as that from the American College of Obstetricians and Gynaecologists (ACOG), American Society for Reproductive Medicine (ASRM), Canadian Fertility and Andrology Society (CFAS), and Royal College of Obstetricians and Gynaecologists (RCOG).

Results

A simple guide for the clinicians to manage the infertile couples.

Conclusions

The study deploys a new strategy to translate the research findings and evidence-base recommendations into a simplified focused guide to be applied on routine daily practice. It is an approach to disseminate the recommended medical care for infertile couple to the practicing clinicians.
Literature
1.
go back to reference World Health Organization: Report of the Meeting on the Prevention of Infertility at the Primary Health Care Level. 1983, WHO, Geneva, WHO/MCH/1984.4. World Health Organization: Report of the Meeting on the Prevention of Infertility at the Primary Health Care Level. 1983, WHO, Geneva, WHO/MCH/1984.4.
2.
go back to reference Cates W, Farley TM, Rowe PJ: Worldwide patterns of infertility: is Africa different?. Lancet. 1985, 2: 596-598. 10.1016/S0140-6736(85)90594-X.CrossRefPubMed Cates W, Farley TM, Rowe PJ: Worldwide patterns of infertility: is Africa different?. Lancet. 1985, 2: 596-598. 10.1016/S0140-6736(85)90594-X.CrossRefPubMed
3.
go back to reference Zargar AH, Wani AI, Masoodi SR, Laway BA, Salahuddin M: Epidemiologic and etiologic aspects of primary infertility in the Kashmir region of India. Fertil Steril. 1997, 68: 637-643. 10.1016/S0015-0282(97)00269-0.CrossRefPubMed Zargar AH, Wani AI, Masoodi SR, Laway BA, Salahuddin M: Epidemiologic and etiologic aspects of primary infertility in the Kashmir region of India. Fertil Steril. 1997, 68: 637-643. 10.1016/S0015-0282(97)00269-0.CrossRefPubMed
4.
go back to reference Whitman-Elia GF, Baxley EG: A Primary Care Approach to the Infertile Couple: Clinical Review. J Am Board Family Pract. 2001, 14: 33-45. Whitman-Elia GF, Baxley EG: A Primary Care Approach to the Infertile Couple: Clinical Review. J Am Board Family Pract. 2001, 14: 33-45.
5.
go back to reference Irvine S: Guidelines in the treatment of male infertility. Int Cong Series. 2004, 1266: 202-207. 10.1016/j.ics.2004.01.071.CrossRef Irvine S: Guidelines in the treatment of male infertility. Int Cong Series. 2004, 1266: 202-207. 10.1016/j.ics.2004.01.071.CrossRef
6.
go back to reference Morrison J, Carroll L, Twaddle S, Cameron I, Grimshaw J, Leyland A, Baillie H, Watt G: Pragmatic randomised controlled trial to evaluate guidelines for the management of infertility across the primary care-secondary care interface. BMJ. 2001, 322 (7297): 1282-84. 10.1136/bmj.322.7297.1282.PubMedCentralCrossRefPubMed Morrison J, Carroll L, Twaddle S, Cameron I, Grimshaw J, Leyland A, Baillie H, Watt G: Pragmatic randomised controlled trial to evaluate guidelines for the management of infertility across the primary care-secondary care interface. BMJ. 2001, 322 (7297): 1282-84. 10.1136/bmj.322.7297.1282.PubMedCentralCrossRefPubMed
7.
go back to reference Poppe K, Velkeniers B: Thyroid and infertility. Verh K Acad Geneeskd Belg. 2002, 64 (6): 389-399.PubMed Poppe K, Velkeniers B: Thyroid and infertility. Verh K Acad Geneeskd Belg. 2002, 64 (6): 389-399.PubMed
8.
go back to reference Razzak AH, Wais SA: The infertile couple: A cohort study in Duhok, Iraq. Est Mediterr Health J. 2002, 8 (2-3): 234-238. Razzak AH, Wais SA: The infertile couple: A cohort study in Duhok, Iraq. Est Mediterr Health J. 2002, 8 (2-3): 234-238.
9.
go back to reference Ikechebula JI, Adinma JI, Orie EF, Ikegwuonu SO: High prevalence of male infertility in Southeastern Nigeria. J Obstet Gynecol. 2003, 23 (6): 657-659.CrossRef Ikechebula JI, Adinma JI, Orie EF, Ikegwuonu SO: High prevalence of male infertility in Southeastern Nigeria. J Obstet Gynecol. 2003, 23 (6): 657-659.CrossRef
10.
go back to reference Araoye MO: Epidemiology of infertility: Social problems of the infertile couples. West Afr J Med. 2003, 22 (2): 109-106. Araoye MO: Epidemiology of infertility: Social problems of the infertile couples. West Afr J Med. 2003, 22 (2): 109-106.
11.
go back to reference Tolstrup IS, Kjaer SK, Hoist C, Sharif H, Munk C, osier M: Alcohol use as predictor for infertility in a representative population of Danish women. Acta Obstet gynecol Scand. 2003, 82 (8): 744-749.CrossRefPubMed Tolstrup IS, Kjaer SK, Hoist C, Sharif H, Munk C, osier M: Alcohol use as predictor for infertility in a representative population of Danish women. Acta Obstet gynecol Scand. 2003, 82 (8): 744-749.CrossRefPubMed
12.
go back to reference Saleh RA, Agarwal A, Sharma RK, Nelson DR, Thomas AJ: Effect of cigarette smoking on levels of seminal oxidative stress in infertile men: A prospective study. Fertil Steril. 2002, 78 (3): 491-499. 10.1016/S0015-0282(02)03294-6.CrossRefPubMed Saleh RA, Agarwal A, Sharma RK, Nelson DR, Thomas AJ: Effect of cigarette smoking on levels of seminal oxidative stress in infertile men: A prospective study. Fertil Steril. 2002, 78 (3): 491-499. 10.1016/S0015-0282(02)03294-6.CrossRefPubMed
13.
go back to reference Esimai OA, Orji EO, Lasisi AR: Male contribution to infertility in Nigeria. Niger Med. 2002, 11 (2): 70-72. Esimai OA, Orji EO, Lasisi AR: Male contribution to infertility in Nigeria. Niger Med. 2002, 11 (2): 70-72.
14.
go back to reference Olatunji AO, Sule-odu AO: The pattern of infertility cases at a university hospital. West Afr J Med. 2003, 22 (3): 205-207.PubMed Olatunji AO, Sule-odu AO: The pattern of infertility cases at a university hospital. West Afr J Med. 2003, 22 (3): 205-207.PubMed
15.
go back to reference Bayasgalan G, Naranbat D, Tsedmaa B, Tsogmaa B, Sukhee D, Amarjargal O, Lhagvasuren T, Radnaabazar J, Rowe PJ: Clinical patterns and major causes of infertility in Mongolia. J Obstet Gynaecol Res. 2004, 30 (5): 386-393. 10.1111/j.1447-0756.2004.00217.x.CrossRefPubMed Bayasgalan G, Naranbat D, Tsedmaa B, Tsogmaa B, Sukhee D, Amarjargal O, Lhagvasuren T, Radnaabazar J, Rowe PJ: Clinical patterns and major causes of infertility in Mongolia. J Obstet Gynaecol Res. 2004, 30 (5): 386-393. 10.1111/j.1447-0756.2004.00217.x.CrossRefPubMed
16.
go back to reference Speroff L, Glass RH, Kase NG: Female infertility. Clinical Gynecologic Endocrinology and Infertility. 1999, Lippincott Williams & Wilkins, Philadelphia, PA, USA, 6 Speroff L, Glass RH, Kase NG: Female infertility. Clinical Gynecologic Endocrinology and Infertility. 1999, Lippincott Williams & Wilkins, Philadelphia, PA, USA, 6
17.
go back to reference Forti G, Krausz C: Evaluation and Treatment of the Infertile Couple. J Clin Endocrinol Metab. 1998, 83 (12): 4177-4188. 10.1210/jc.83.12.4177.PubMed Forti G, Krausz C: Evaluation and Treatment of the Infertile Couple. J Clin Endocrinol Metab. 1998, 83 (12): 4177-4188. 10.1210/jc.83.12.4177.PubMed
18.
go back to reference Whitman-Elia GF, Baxley EG: A primary care approach to the infertile couple: Clinical review. J Am Board Fam Pract. 2001, 14: 33-45.PubMed Whitman-Elia GF, Baxley EG: A primary care approach to the infertile couple: Clinical review. J Am Board Fam Pract. 2001, 14: 33-45.PubMed
19.
go back to reference Case AM: Infertility evaluation and management: Strategies for family physicians. Canadian Family Physician. 2003, 49: 1465-1472.PubMedCentralPubMed Case AM: Infertility evaluation and management: Strategies for family physicians. Canadian Family Physician. 2003, 49: 1465-1472.PubMedCentralPubMed
21.
go back to reference Colpi GM, Hargreave TB, Papp GK, Pomerol JM, Weidner W: Guidelines on Infertility. 2004, European Association of Urology, Arnhem, Netherlands, 1-58. Colpi GM, Hargreave TB, Papp GK, Pomerol JM, Weidner W: Guidelines on Infertility. 2004, European Association of Urology, Arnhem, Netherlands, 1-58.
22.
go back to reference National Institute for Clinical Excellence (NICE) guideline 11: Fertility: Assessment and treatment for people with fertility problems, Clinical Guideline. 2004, RCOG press, London National Institute for Clinical Excellence (NICE) guideline 11: Fertility: Assessment and treatment for people with fertility problems, Clinical Guideline. 2004, RCOG press, London
23.
go back to reference The Practice Committee of the American Society for Reproductive Medicine: Vaccination guidelines for female infertility patients. Fertil Steril. 2008, 90: S169-171. The Practice Committee of the American Society for Reproductive Medicine: Vaccination guidelines for female infertility patients. Fertil Steril. 2008, 90: S169-171.
24.
go back to reference The ESHRE Capri Workshop Group: Diagnosis and management of the infertile couple: missing information. Hum Reprod Update. 2004, 10 (4): 295-307. 10.1093/humupd/dmh024.CrossRef The ESHRE Capri Workshop Group: Diagnosis and management of the infertile couple: missing information. Hum Reprod Update. 2004, 10 (4): 295-307. 10.1093/humupd/dmh024.CrossRef
25.
go back to reference Jose-Miller AB, Boyden JW, Frey KA: Infertility. Am Fam Physician. 2007, 75: 849-856.PubMed Jose-Miller AB, Boyden JW, Frey KA: Infertility. Am Fam Physician. 2007, 75: 849-856.PubMed
26.
go back to reference Macaluso M, Wright-Schnapp TJ, Chandra A, Johnson R, Satterwhite CL, Pulver A, Berman SM, Wang RY, Farr SL, Pollack LA: A public health focus on infertility prevention, detection, and management. Fertil Steril. 2010, 93 (1): 16-e1-16e10. 10.1016/j.fertnstert.2008.09.046.CrossRef Macaluso M, Wright-Schnapp TJ, Chandra A, Johnson R, Satterwhite CL, Pulver A, Berman SM, Wang RY, Farr SL, Pollack LA: A public health focus on infertility prevention, detection, and management. Fertil Steril. 2010, 93 (1): 16-e1-16e10. 10.1016/j.fertnstert.2008.09.046.CrossRef
27.
go back to reference World Health Organization: WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction. 1999, Cambridge University Press, Cambridge World Health Organization: WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction. 1999, Cambridge University Press, Cambridge
29.
go back to reference Balasch J: Investigation of the infertile couple in the era of assisted reproductive technology: a time for reappraisal. Hum Reprod. 2000, 15: 2251-2257. 10.1093/humrep/15.11.2251.CrossRefPubMed Balasch J: Investigation of the infertile couple in the era of assisted reproductive technology: a time for reappraisal. Hum Reprod. 2000, 15: 2251-2257. 10.1093/humrep/15.11.2251.CrossRefPubMed
30.
go back to reference Rowe PJ, Comhaire FH, Hargreave TB, Mahmoud AMA: WHO Manual for the standardized Investigation, Diagnosis and Management of the Infertile Male. 2000, Cambridge University Press, Cambridge, 54- Rowe PJ, Comhaire FH, Hargreave TB, Mahmoud AMA: WHO Manual for the standardized Investigation, Diagnosis and Management of the Infertile Male. 2000, Cambridge University Press, Cambridge, 54-
31.
go back to reference The ESHRE Capri Workshop Group: Optimal use of infertility diagnostic tests and treatments. Hum Reprod. 2000, 15 (3): 723-732. 10.1093/humrep/15.3.723.CrossRef The ESHRE Capri Workshop Group: Optimal use of infertility diagnostic tests and treatments. Hum Reprod. 2000, 15 (3): 723-732. 10.1093/humrep/15.3.723.CrossRef
32.
go back to reference Foresta C, Ferlin A, Gianaroli L, Dallapiccola B: Guidelines for the appropriate use of genetic tests in infertile couples. Euro J Hum Gene. 2002, 10: 303-312. 10.1038/sj.ejhg.5200805.CrossRef Foresta C, Ferlin A, Gianaroli L, Dallapiccola B: Guidelines for the appropriate use of genetic tests in infertile couples. Euro J Hum Gene. 2002, 10: 303-312. 10.1038/sj.ejhg.5200805.CrossRef
33.
go back to reference Fatum M, Laufer N, Simon A: Investigation of the infertile couple: Should diagnostic laparoscopy be performed after normal hysterosalpingography in treating infertility suspected to be of unknown origin?. Hum Reprod. 2002, 17 (1): 1-3. 10.1093/humrep/17.1.1.CrossRefPubMed Fatum M, Laufer N, Simon A: Investigation of the infertile couple: Should diagnostic laparoscopy be performed after normal hysterosalpingography in treating infertility suspected to be of unknown origin?. Hum Reprod. 2002, 17 (1): 1-3. 10.1093/humrep/17.1.1.CrossRefPubMed
34.
go back to reference Shahin AY: problem of IVF cost in developing countries: has natural cycle IVF a place?. RBM Online. 2007, 15 (1): 51-56.PubMed Shahin AY: problem of IVF cost in developing countries: has natural cycle IVF a place?. RBM Online. 2007, 15 (1): 51-56.PubMed
35.
go back to reference Vayena E, Peterson H, Adamson D, Nygren K-G: Assisted reproductive technologies in developing countries: are we caring yet?. Fertil Steril. 2009, 92 (2): 413-416. 10.1016/j.fertnstert.2009.02.011.CrossRefPubMed Vayena E, Peterson H, Adamson D, Nygren K-G: Assisted reproductive technologies in developing countries: are we caring yet?. Fertil Steril. 2009, 92 (2): 413-416. 10.1016/j.fertnstert.2009.02.011.CrossRefPubMed
36.
go back to reference Oladokun A, Arulogun O, Oladokun R, Morhason-Bello I, Bamgboye E, Adewole I, Ojengbede OA: Acceptability of child adoption as management option for infertility in Nigeria: Evidence from focus group discussions. Afr J Reprod Health. 2009, 13 (1): 79-91.PubMed Oladokun A, Arulogun O, Oladokun R, Morhason-Bello I, Bamgboye E, Adewole I, Ojengbede OA: Acceptability of child adoption as management option for infertility in Nigeria: Evidence from focus group discussions. Afr J Reprod Health. 2009, 13 (1): 79-91.PubMed
37.
go back to reference Brinsden P, Hartshorne G, Hirsh A, Owen E: Reproductive Medicine: From A to Z. 1998, Oxford. Oxford University Press, UK Brinsden P, Hartshorne G, Hirsh A, Owen E: Reproductive Medicine: From A to Z. 1998, Oxford. Oxford University Press, UK
39.
go back to reference Boivin J, Appleton TC, Baetens P, Baron J, Bitzer J, Corrigan E, Daniels KR, Darwish J, Guerra-Diaz D, Hammar M, McWhinnie A, Strauss B, Thorn P, Wischmann T, Kentenich H: Guidelines for counselling in infertility: outline version. Hum Reprod. 2001, 16 (6): 1301-1304. 10.1093/humrep/16.6.1301.CrossRefPubMed Boivin J, Appleton TC, Baetens P, Baron J, Bitzer J, Corrigan E, Daniels KR, Darwish J, Guerra-Diaz D, Hammar M, McWhinnie A, Strauss B, Thorn P, Wischmann T, Kentenich H: Guidelines for counselling in infertility: outline version. Hum Reprod. 2001, 16 (6): 1301-1304. 10.1093/humrep/16.6.1301.CrossRefPubMed
41.
go back to reference Verkauf BS: The incidence and outcome of single factor, multifactorial, and unexplained infertility. Am J Obstet Gynecol. 1983, 147: 175-181.PubMed Verkauf BS: The incidence and outcome of single factor, multifactorial, and unexplained infertility. Am J Obstet Gynecol. 1983, 147: 175-181.PubMed
42.
go back to reference Collins JA, Rowe TC: Age of the female partner is a prognostic factor in prolonged unexplained infertility: a multicenter study. Fertil Steril. 1989, 52: 15-20.PubMed Collins JA, Rowe TC: Age of the female partner is a prognostic factor in prolonged unexplained infertility: a multicenter study. Fertil Steril. 1989, 52: 15-20.PubMed
43.
go back to reference Schmidt L: Psychosocial burden of infertility and assisted reproduction. Lancet. 2006, 367: 379-380. 10.1016/S0140-6736(06)68117-8.CrossRefPubMed Schmidt L: Psychosocial burden of infertility and assisted reproduction. Lancet. 2006, 367: 379-380. 10.1016/S0140-6736(06)68117-8.CrossRefPubMed
44.
go back to reference Dyer SJ, Abrahams N, Mokoena NE, Lombard CJ, Spuy van der ZM: Psychological distress among women suffering from couple infertility in South Africa: a quantitative assessment. Hum Reprod. 2005, 20 (7): 1938-1943. 10.1093/humrep/deh845.CrossRefPubMed Dyer SJ, Abrahams N, Mokoena NE, Lombard CJ, Spuy van der ZM: Psychological distress among women suffering from couple infertility in South Africa: a quantitative assessment. Hum Reprod. 2005, 20 (7): 1938-1943. 10.1093/humrep/deh845.CrossRefPubMed
45.
go back to reference Gillerot Y, Jauniaux E, van Maldergem L, Fourneau C: Pathogenesis of human malformations. The First Twelve Weeks of Gestation. Edited by: Barnea ER, Hustin J, Jauniaux E. 1992, Springer-Verlag, Berlin, 328-CrossRef Gillerot Y, Jauniaux E, van Maldergem L, Fourneau C: Pathogenesis of human malformations. The First Twelve Weeks of Gestation. Edited by: Barnea ER, Hustin J, Jauniaux E. 1992, Springer-Verlag, Berlin, 328-CrossRef
46.
go back to reference Abdalla HI, Rizk B: Intracytoplasmic sperm injection. Assisted Reproductive Technologies. Edited by: Abdalla HI, Rizk B. 1999, Oxford Health Press, Abingdon, 57- Abdalla HI, Rizk B: Intracytoplasmic sperm injection. Assisted Reproductive Technologies. Edited by: Abdalla HI, Rizk B. 1999, Oxford Health Press, Abingdon, 57-
47.
go back to reference Bhattacharya S, Hamilton MP, Shaaban M, Khalaf Y, Seddler M, Ghobara T, Braude P, Kennedy R, Rutherford A, Hartshorne G, Templeton A: Conventional in-vitro fertilisation versus intracytoplasmic sperm injection for the treatment of non-male-factor infertility: A randomised controlled trial. Lancet. 2001, 357 (9274): 2075-2079. 10.1016/S0140-6736(00)05179-5.CrossRefPubMed Bhattacharya S, Hamilton MP, Shaaban M, Khalaf Y, Seddler M, Ghobara T, Braude P, Kennedy R, Rutherford A, Hartshorne G, Templeton A: Conventional in-vitro fertilisation versus intracytoplasmic sperm injection for the treatment of non-male-factor infertility: A randomised controlled trial. Lancet. 2001, 357 (9274): 2075-2079. 10.1016/S0140-6736(00)05179-5.CrossRefPubMed
Metadata
Title
Management of the infertile couple: an evidence-based protocol
Author
Remah M Kamel
Publication date
01-12-2010
Publisher
BioMed Central
Published in
Reproductive Biology and Endocrinology / Issue 1/2010
Electronic ISSN: 1477-7827
DOI
https://doi.org/10.1186/1477-7827-8-21

Other articles of this Issue 1/2010

Reproductive Biology and Endocrinology 1/2010 Go to the issue