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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 (American Society for Reproductive Medicine, 2008a). Ten to 15 percent of the reproductive-aged population is infertile, and men and women are equally affected.

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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.

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In general, a first step involves identification of a primary cause and contributing factors, and treatment is aimed at their direct correction. Most couples 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 required.

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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 disadvantages. 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. Lastly, infertility treatment can be a financial burden, a significant source of emotional stress, or both.

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An infertility specialist should not dictate treatment, but should offer and explain therapy options, which may include expectant management or even adoption.

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Environmental Factors

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Increasing information suggests that some male and female infertility may result from environmental contaminants or toxins (Giudice, 2006). Endocrine-disrupting chemicals such as dioxins and polychlorinated biphenyls, as well as agricultural pesticides and herbicides, phthalates (used in making plastic materials), lead, and bisphenol A (used in the manufacture of polycarbonate plastic and resins), have been shown to be reproductive toxicants (Hauser, 2008; Mendola, 2008). Although direct links to infertility in humans are not conclusive, clinicians should counsel patients that environmental exposures to toxic substances should be avoided if possible. Currently, these cautions should be discussed carefully to avoid alarm.

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Smoking

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At least one fifth of reproductive-aged men and women in the United States smoke cigarettes (Centers for Disease Control and Prevention, 2011). Several comprehensive reviews have summarized cumulative data on cigarette smoking and female fecundity, and all support the conclusion that smoking has an adverse effect (American Society for Reproductive Medicine, 2008d). Moreover, smoking's negative effects on female fecundity do not appear to be overcome by assisted ...

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