1 - Clinical assessment of the woman for assisted conception

Summary

In the last four decades significant progress has been made in the diagnosis and treatment of infertile couples. It is currently estimated that about 90% of women will achieve pregnancy in the first year of trying to conceive and 95% within the second year, following which the chances of natural conception are lower. The remaining 5–10% can be defined as infertile and requiring investigation and treatment (WHO, 1992; ESHRE Capri Workshop, 1996). This timeframe can be shorter in women with risk factors such as previous history of pelvic inflammatory disease (PID), pelvic surgery, ectopic pregnancy, family history of premature ovarian failure and in women aged 35 years and over due to the natural age-related decline in fertility (van Noord-Zaadstra et al., 1991). Increasing numbers of women are delaying childbearing to an age when they are more likely to encounter problems with conceiving, and public awareness of the scientific progress made in the field of assisted conception has led to an increased number of people seeking treatment.

The first consultation between an infertile couple and the clinician specializing in infertility is a crucial starting point for collecting the medical history, clinical examination and the evaluation of the appropriateness of a range of investigations to establish the cause of infertility, following which a strategy for treatment can be planned. When infertile couples present at tertiary assisted conception centres often they will have been referred by a general practitioner or gynaecologist and may already have completed basic infertility assessment. In this event it is often possible to discuss treatment strategies during the first consultation.