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Hum. Reprod. Advance Access published online on March 31, 2005
Human Reproduction, doi:10.1093/humrep/deh870
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received August 31, 2004
Revised December 20, 2004
Accepted February 17, 2005

Debate

Debate continued: Definition and prevalence of subfertility and infertility

C. Gnoth 1*, E. Godehardt 2, P. Frank-Herrmann 3, K. Friol 1, Jürgen Tigges 1, and G. Freundl 4

1 Center for Family Planning, Gynaecological Endocrinology & Reproductive Medicine Grevenbroich, Germany
2 Biometric Research Group, Clinic for Thoracic and Cardiovascular Surgery, Heinrich-Heine University of Duesseldorf, Germany
3 Department of Gynaecological Endocrinology, University of Heidelberg, Germany
4 Department of Reproductive Medicine, Staedtische Kliniken Duesseldorf gGmbH, Frauenklinik Benrath, Germany


  Abstract

A common definition of sub- and infertility is very important for the appropriate management of infertility. Subfertility generally describes any form of reduced fertility with prolonged time of unwanted non-conception. Infertility may be used synonymously with sterility with only sporadically occurring spontaneous pregnancies. The major factor affecting the individual spontaneous pregnancy prospect is the time of unwanted non-conception which determines the grading of subfertility. Most of the pregnancies occur in the first six cycles with intercourse in the fertile phase (80%). After that, serious subfertility must be assumed in every second couple (10%) although--after 12 unsuccessful cycles--untreated live birth rates among them will reach nearly 55% in the next 36 months. Thereafter (48 months), ~5% of the couples are definitive infertile with a nearly zero chance of becoming spontaneously pregnant in the future. With age, cumulative probabilities of conception decline because heterogeneity in fecundity increases due to a higher proportion of infertile couples. In truly fertile couples cumulative probabilities of conception are probably age independent. Under appropriate circumstances a basic infertility work-up after six unsuccessful cycles with fertility-focused intercourse will identify couples with significant infertility problems to avoid both infertility under- and over-treatment, regardless of age: Couples with a reasonably good prognosis (e.g. unexplained infertility) may be encouraged to wait because even with treatment they do not have a better chance of conceiving. The others may benefit from an early resort to assisted reproduction treatment.

Keywords: definition of subfertility; fertility awareness; management of infertility; prevalence of infertility; time to pregnancy.
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