++
Infertility results from diseases of the reproductive system that impair the body’s ability to perform basic reproductive function. It is defined as the failure to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse. Earlier evaluation and treatment may be justified based on medical history and physical findings and is warranted after 6 months for women older than 35 (American Society for Reproductive Medicine, 2012b). Ten to 15 percent of the reproductive-aged population is infertile, and men and women are equally affected.
++
Infertility treatment is a complex process influenced by numerous factors. Important considerations include duration of infertility, a couple’s age (especially the female’s), and diagnosed cause. Additionally, the level of distress experienced by a couple should be taken into account.
++
In general, a first step involves identification of a primary cause and contributing factors, and treatment is aimed at their direct correction. Most are treated with conventional therapies such as medication or surgery. In many cases, therapy can begin without a complete evaluation, especially if a cause is obvious. However, if pregnancy does not quickly follow, then more thorough testing is prudent.
++
In contrast, evaluation commonly may not yield a satisfactory explanation or may identify causes that are not amenable to direct correction. For such cases, recent advances in assisted reproduction have provided effective treatments. These approaches, however, are not without disadvantage. For example, in vitro fertilization (IVF) has been linked with higher rates of some fetal and maternal complications. Appropriate treatments may also pose ethical dilemmas for couples or their physician. For example, selective reduction of a multifetal pregnancy may improve survival chances for some fetuses but at the cost of others. Last, infertility treatment can be a financial burden, a significant source of emotional stress, or both. During consultation, an infertility specialist does not dictate treatment but offers and explains therapy options, which may include expectant management or even adoption.
++
Ovarian function is dependent on weight. Low body-fat content is associated with hypothalamic hypogonadism. In contrast, central body fat is associated with insulin resistance and contributes to ovarian dysfunction in many women with polycystic ovarian syndrome (PCOS). Lifestyle modification in overweight infertile women with PCOS leads to a reduction of central fat and improved insulin sensitivity, decreased hyperandrogenemia, lowered luteinizing hormone (LH) concentrations, and restoration of normal fertility in many cases (Hoeger, 2001; Kiddy, 1992). Even a 5 to 10 percent reduction in body weight has been shown to be successful in these women (Crosignani, 2003; Kiddy, 1992; Pasquali, 1989). Apart from diet, exercise can also improve insulin sensitivity. Weight loss and exercise are inexpensive and should be recommended as first-line management of obese women with PCOS.
++
Although pharmacologic options can effectively treat anovulation if weight cannot be lost, ...