13. Infertility

If a couple has failed to conceive spontaneously in 12 months of unprotected intercourse we speak of infertility. About 1 out of 7 couples seek medical guidance for infertility. Due to postponing childbearing this number might increase in the future. Infertility is a disability and should be investigated properly. Factors influencing fertility should be assessed and a work-up for both men and women should be performed. This includes a semen analysis, assessment of the menstrual cycle and evaluation of tubal pathology or other diseases that could influence fertility. If results reveal that a couple cannot conceive spontaneously, they are infertile and appropriate treatment should be offered. Idiopathic infertility means that no cause for infertility was found. In those cases a prognosis should be predicted to evaluate whether a couple should be advised to enter a fertility treatment program or still has sufficient chances of a spontaneous pregnancy within 6–12 months and should therefore be counselled for expectant management.