Definition of Infertility

The Take Home Baby Rate depends on the rate of conception as well as the survival of the gestation, which in the case of infertility is determined to a large extent by the rate of miscarriages.

By convention, when one refers to a patient as infertile, this means a low rate of conception, since infertility is rarely absolute (sterility).

As mentioned above, in normal people, age represents the most determinant factor for the rate of conception.

When all the other factors are constant, a couple in which the woman is 25 years old or less has 5 to 6 chances to conceive the year following the discontinuation of contraceptive measures.
If pregnancy is not achieved by then, despite the occurrence of a normal menstrual cycle and normal s*xual life, most experts would accept that this couple has an infertility problem and would recommend investigation and treatment.

If there is a medical history of menstrual disorders, the evaluation of the woman’s fertility should consider the time period necessary to display all 12 or 13 ovulations which women with normal menstrual cycles have in one year.

It is clear that if one woman has 4 ovulations in one year, she will need 3 times more time to achieve the same possibility to becoming pregnant in comparison to a woman with a normal menstrual cycle. In this case it is not worth delaying the medical investigation of the patient for 1year.

Likewise, if there is a history of Pelvic Inflammatory Disease (PID), severe appendicitis (especially in the case of peritonitis), or if the spouse has a history of testitis, or a history of cryptorchidism, the investigation must commence even sooner.

A more difficult problem is to define infertility in a couple with a relatively old woman.

At first, someone could think to delay the investigation for the reason that a 35 years old woman or older needs more time to achieve a certain conception rate.

On the other hand, the slope of the curve that gives the correlation of the risk for childlessness as a function of age gets more abrupt as women approach the age of 40.

Therefore, there is little time to lose in such couples and in our practice we are more offensive in recommending investigation and treatment when the patient is older than 35.

There seems to be no benefit in waiting beyond one year and in most women (especially those with some diagnostic signs in their medical history) we recommend they begin their investigation after 6 months of unprotected s*xual intercourse.