Highlights & Basics
- Infertility in women is commonly caused by ovulatory dysfunction, tubal or other anatomic disorders, endometriosis, or unexplained infertility.
- The workup requires the evaluation of reproductive anatomy and physiology, and the lifestyle of the couple. In some cases, the diagnosis is unexplained if the definition of infertility is met but all investigations are normal.
- Management options are diagnosis-dependent, with emphasis on female age. They may include expectant treatment, medical therapy, surgical therapy, or assisted fertility treatments.
- Fertility outcomes are dependent on female age, infertility diagnosis, and access to assisted fertility treatments.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
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Citations
National Institute for Health and Care Excellence. Fertility problems: assessment and treatment. Sep 2017 [internet publication].[Full Text]
European Society of Human Reproduction and Embryology. Unexplained infertility: guideline of European Society of Human Reproduction and Embryology. 2023 [internet publication].[Full Text]
Buckett W, Sierra S. The management of unexplained infertility: an evidence-based guideline from the Canadian Fertility and Andrology Society. Reprod Biomed Online. 2019 Oct;39(4):633-40.[Abstract][Full Text]
Practice Committee of the American Society for Reproductive Medicine. Evidence-based treatments for couples with unexplained infertility: a guideline. Fertil Steril. 2020 Feb;113(2):305-22.[Abstract][Full Text]
1. National Institute for Health and Care Excellence. Fertility problems: assessment and treatment. Sep 2017 [internet publication].[Full Text]
2. European Society of Human Reproduction and Embryology. Unexplained infertility: guideline of European Society of Human Reproduction and Embryology. 2023 [internet publication].[Full Text]
3. Mascarenhas MN, Flaxman SR, Boerma T, et al. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med. 2012;9(12):e1001356.[Abstract][Full Text]
4. Speroff L, Fritz MA. Female infertility. In: Clinical gynecologic endocrinology and infertility. 7th ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2005:1028.
5. Gupta S, Goldberg JM, Aziz N, et al. Pathogenic mechanisms in endometriosis-associated infertility. Fertil Steril. 2008 Aug;90(2):247-57.[Abstract]
6. Raperport C, Desai J, Qureshi D, et al. The definition of unexplained infertility: a systematic review. BJOG. 2024 Jun;131(7):880-97.[Abstract][Full Text]
7. World Health Organization. Infertility prevalence estimates, 1990-2021. Apr 2023 [internet publication].[Full Text]
8. Centers for Disease Control and Prevention. Key statistics from the national survey of family growth - I listing. Dec 2022 [internet publication].[Full Text]
9. QuickStats: percentage of women aged 25-44 years who had ever used infertility services, by type of service - National Survey of Family Growth, United States, 2006-2010 and 2015-2019. MMWR Morb Mortal Wkly Rep. 2021 Oct 8;70(40):1433.[Abstract][Full Text]
10. Centers for Disease Control and Prevention. 2021 assisted reproductive technology fertility clinic and national summary report. Atlanta, GA: US Dept of Health and Human Services; 2023.[Full Text]
11. Lindsay TJ, Vitrikas KR. Evaluation and treatment of infertility. Am Fam Physician. 2015 Mar 1;91(5):308-14. Erratum in: Am Fam Physician. 2015 Sep 15;92 (6):437.[Abstract][Full Text]
12. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and Practice Committee. Female age-related fertility decline. Committee Opinion No. 589. Fertil Steril. 2014 Mar;101(3):633-4.[Abstract][Full Text]
13. American College of Obstetricians and Gynecologists' Committee on Clinical Consensus-Obstetrics; Gantt A; Society for Maternal-Fetal Medicine; et al. Obstetric Care Consensus #11, Pregnancy at age 35 years or older. Am J Obstet Gynecol. 2023 Mar;228(3):B25-40.[Abstract][Full Text]
14. Carson SA, Kallen AN. Diagnosis and management of infertility: a review. JAMA. 2021 Jul 6;326(1):65-76.[Abstract][Full Text]
15. Practice Committee of the American Society for Reproductive Medicine. Tobacco or marijuana use and infertility: a committee opinion. Fertil Steril. 2024 Apr;121(4):589-603.[Abstract][Full Text]
16. Broughton DE, Moley KH. Obesity and female infertility: potential mediators of obesity's impact. Fertil Steril. 2017 Apr;107(4):840-7.[Abstract][Full Text]
17. Huhmann K. Menses requires energy: a review of how disordered eating, excessive exercise, and high stress lead to menstrual irregularities. Clin Ther. 2020 Mar;42(3):401-7.[Abstract][Full Text]
18. Munro MG, Balen AH, Cho S, et al. The FIGO ovulatory disorders classification system. Int J Gynecol Obstet. 2022 Aug 19;159:1-20.[Full Text]
19. Tsevat DG, Wiesenfeld HC, Parks C, et al. Sexually transmitted diseases and infertility. Am J Obstet Gynecol. 2017 Jan;216(1):1-9.[Abstract][Full Text]
20. Paavonen J, Eggert-Kruse W. Chlamydia trachomatis: impact on human reproduction. Hum Reprod Update. 1999 Sep-Oct;5(5):433-47.[Abstract]
21. den Hartog JE, Morre SA, Land JA. Chlamydia trachomatis-associated tubal factor subfertility: immunogenetic aspects and serological screening. Hum Reprod Update. 2006 Nov-Dec;12(6):719-30.[Abstract][Full Text]
22. Westrom L. Sexually transmitted diseases and infertility. Sex Trans Dis. 1994 Mar-Apr;21(2 Suppl):S32-7.[Abstract]
23. Leyland NC, Awadalla AB, Rittenberg F. Endometriosis: Diagnosis and management. Journal of Endometriosis. 2010 Jul 1;2(3):107-34.
24. The Royal College of Obstetricians and Gynaecologists. The effect of surgery for endometriomas on fertility: scientific impact paper no. 55. Sep 2017 [internet publication].[Full Text]
25. Paffoni A, Casalechi M, De Ziegler D, et al. Live birth after oocyte donation in vitro fertilization cycles in women with endometriosis: a systematic review and meta-analysis. JAMA Netw Open. 2024 Jan 2;7(1):e2354249.[Abstract][Full Text]
26. Abruzzo MA, Hassold TJ. Etiology of nondisjunction in humans. Environ Mol Mutagen. 1995;25 Suppl 26:38-47.[Abstract]
27. Battaglia DE, Goodwin P, Klein NA, et al. Influence of maternal age on meiotic spindle assembly in oocytes from naturally cycling women. Hum Reprod. 1996 Oct;11(10):2217-22.[Abstract]
28. Keefe DL, Liu L, Marquard K. Telomeres and aging-related meiotic dysfunction in women. Cell Mol Life Sci. 2007 Jan;64(2):139-43.[Abstract]
29. Med Nexus. Guideline for diagnosis and treatment of infertility in advanced age women (revised edition). Sep 2017 [internet publication].[Full Text]
30. Hassan MA, Lavery SA, Trew GH. Congenital uterine anomalies and their impact on fertility. Womens Health (Lond Engl). 2010 May;6(3):443-61.[Abstract][Full Text]
31. Akhtar MA, Saravelos SH, Li TC, et al. Reproductive implications and management of congenital uterine anomalies: scientific impact paper no. 62 November 2019. BJOG. 2020 Apr;127(5):e1-13.[Abstract][Full Text]
32. Pritts TL, Ogden M, Parker W, et al. Intramural leiomyomas and fertility: a systematic review and meta-analysis. Obstet Gynecol. 2024 Aug 1;144(2):171-9.[Abstract]
33. Singh N, Sethi A. Endometritis - diagnosis, treatment and its impact on fertility - a scoping review. JBRA Assist Reprod. 2022 Aug 4;26(3):538-46.[Abstract][Full Text]
34. Wu HM, Tsai TC, Liu SM, et al. The current understanding of molecular mechanisms in adenomyosis-associated infertility and the treatment strategy for assisted reproductive technology. Int J Mol Sci. 2024 Aug 16;25(16):8937.[Abstract][Full Text]
35. van Noord-Zaadstra BM, Looman CW, Alsbach H, et al. Delaying childbearing: effect of age on fecundity and outcome of pregnancy. BMJ. 1991 Jun 8;302(6789):1361-5.[Abstract]
36. Tang W, Mao J, Li KT, et al. Pregnancy and fertility-related adverse outcomes associated with Chlamydia trachomatis infection: a global systematic review and meta-analysis. Sex Transm Infect. 2020 Aug;96(5):322-9.[Abstract][Full Text]
37. Chemaitelly H, Majed A, Abu-Hijleh F, et al. Global epidemiology of Neisseria gonorrhoeae in infertile populations: systematic review, meta-analysis and metaregression. Sex Transm Infect. 2021 Mar;97(2):157-69.[Abstract][Full Text]
38. Mantzoros CS. Role of leptin in reproduction. Ann N Y Acad Sci. 2000 Jan 25;900(1):174-83.[Abstract]
39. Moschos S, Chan JL, Mantzoros CS. Leptin and reproduction: a review. Fertil Steril. 2002 Mar;77(3):433-44.[Abstract]
40. Moran LJ, Noakes M, Clifton PM, et al. Dietary composition in restoring reproductive and metabolic physiology in overweight women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2003 Feb;88(2):812-9.[Abstract]
41. Metwally M, Ledger WL, Li TC. Reproductive endocrinology and clinical aspects of obesity in women. Ann N Y Acad Sci. 2008 Apr;1127:140-6.[Abstract]
42. Golden NH, Jacobson MS, Schebendach J, et al. Resumption of menses in anorexia nervosa. Arch Pediatr Adolesc Med. 1997 Jan;151(1):16-21.[Abstract]
43. Levine AH, Pomeroy JC, Wilson TA. Hypothalamic dysfunction at ideal body weight simulating anorexia nervosa. J Pediatr Endocrinol. 1994 Oct-Dec;7(4):357-60.[Abstract]
44. Bale P, Doust J, Dawson D. Gymnasts, distance runners, anorexics body composition and menstrual status. J Sports Med Phys Fitness. 1996 Mar;36(1):49-53.[Abstract]
45. Levine S, Muneyyirci-Delale O. Stress-induced hyperprolactinemia: pathophysiology and clinical approach. Obstet Gynecol Int. 2018;2018:9253083.[Abstract][Full Text]
46. Cooper GS, Baird DD, Hulka BS, et al. Follicle-stimulating hormone concentrations in relation to active and passive smoking. Obstet Gynecol. 1995 Mar;85(3):407-11.[Abstract]
47. Dechanet C, Anahory T, Mathieu Daude JC, et al. Effects of cigarette smoking on reproduction. Hum Reprod Update. 2011 Jan-Feb;17(1):76-95.[Abstract]
48. Khizroeva J, Nalli C, Bitsadze V, et al. Infertility in women with systemic autoimmune diseases. Best Pract Res Clin Endocrinol Metab. 2019 Dec;33(6):101369.[Abstract]
49. Elraiyah T, Hashim Y, Elamin M, et al. The effect of appendectomy in future tubal infertility and ectopic pregnancy: a systematic review and meta-analysis. J Surg Res. 2014 Dec;192(2):368-374.e1.[Abstract]
50. Guo C, Ma W, Fan D, et al. Non spontaneous vaginal delivery was associated with lower probability of subsequent fertility. Eur J Obstet Gynecol Reprod Biol. 2020 May;248:30-6.[Abstract]
51. Sima YT, Magnus MC, Kvalvik LG, et al. The relationship between cesarean delivery and fecundability: a population-based cohort study. Am J Obstet Gynecol. 2024 Jun;230(6):667.e1-21.[Abstract][Full Text]
52. Torre DL, Falorni A. Pharmacological causes of hyperprolactinemia. Ther Clin Risk Manag. 2007 Oct;3(5):929-51.[Abstract][Full Text]
53. Hecht LM, Hadwiger A, Patel S, et al. Disordered eating and eating disorders among women seeking fertility treatment: a systematic review. Arch Womens Ment Health. 2022 Feb;25(1):21-32.[Abstract]
54. Sauer MA, Rifka SM, Hawks RL, et al. Marijuana: interaction with the estrogen receptor. J Pharmacol Exp Ther. 1983 Feb;224(2):404-7.[Abstract]
55. Sansone A, Di Dato C, de Angelis C, et al. Smoke, alcohol and drug addiction and male fertility. Reprod Biol Endocrinol. 2018 Jan 15;16(1):3.[Abstract][Full Text]
56. Reichman ME, Judd JT, Longcope C, et al. Effects of alcohol consumption on plasma and urinary hormone concentrations in premenopausal women. J National Cancer Institute. 1993 May 5;85(9):722-7.[Abstract]
57. Hakim RB, Gray RH, Zacur H. Alcohol and caffeine consumption and decreased fertility. Fertil Steril. 1998 Oct;70(4):632-7.[Abstract]
58. Homan GF, Davies M, Norman R. The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: a review. Hum Reprod Update. 2007 May-Jun;13(3):209-23.[Abstract][Full Text]
59. Bolumar F, Olsen J, Rebagliato M, et al. Caffeine intake and delayed conception: a European multicenter study on infertility and subfecundity. European Study Group on Infertility Subfecundity. Am J Epidemiol. 1997 Feb 15;145(4):324-34.[Abstract]
60. Hassan MA, Killick SR. Negative lifestyle is associated with a significant reduction in fecundity. Fertil Steril. 2004 Feb;81(2):384-92.[Abstract]
61. Bu FL, Feng X, Yang XY, et al. Relationship between caffeine intake and infertility: a systematic review of controlled clinical studies. BMC Womens Health. 2020 Jun 16;20(1):125.[Abstract][Full Text]
62. Lyngsø J, Ramlau-Hansen CH, Bay B, et al. Association between coffee or caffeine consumption and fecundity and fertility: a systematic review and dose-response meta-analysis. Clin Epidemiol. 2017 Dec 15;9:699-719.[Abstract][Full Text]
63. Meyer JD, McDiarmid M, Diaz JH, et al. Reproductive and developmental hazard management. J Occup Environ Med. 2016 Mar;58(3):e94-e102.[Abstract][Full Text]
64. Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Reproductive Endocrinology and Infertility. Optimizing natural fertility: a committee opinion. Fertil Steril. 2022 Jan;117(1):53-63.[Abstract][Full Text]
65. Kahn LG, Harley KG, Siegel EL, et al. Persistent organic pollutants and couple fecundability: a systematic review. Hum Reprod Update. 2021 Feb 19;27(2):339-66.[Abstract][Full Text]
66. Wang W, Hong X, Zhao F, et al. The effects of perfluoroalkyl and polyfluoroalkyl substances on female fertility: a systematic review and meta-analysis. Environ Res. 2023 Jan 1;216(Pt 3):114718.[Abstract]
67. Vessa B, Perlman B, McGovern PG, et al. Endocrine disruptors and female fertility: a review of pesticide and plasticizer effects. F S Rep. 2022 Jun;3(2):86-90.[Abstract][Full Text]
68. Margiana R, Yousefi H, Afra A, et al. The effect of toxic air pollutants on fertility men and women, fetus and birth rate. Rev Environ Health. 2023 Sep 26;38(3):565-76.[Abstract]
69. Sørensen M, Poulsen AH, Nøhr B, et al. Long term exposure to road traffic noise and air pollution and risk of infertility in men and women: nationwide Danish cohort study. BMJ. 2024 Sep 4;386:e080664.[Abstract][Full Text]
70. Nik Hazlina NH, Norhayati MN, Shaiful Bahari I, et al. Worldwide prevalence, risk factors and psychological impact of infertility among women: a systematic review and meta-analysis. BMJ Open. 2022 Mar 30;12(3):e057132.[Abstract][Full Text]
71. Kiani Z, Simbar M, Hajian S, et al. The prevalence of depression symptoms among infertile women: a systematic review and meta-analysis. Fertil Res Pract. 2021 Mar 4;7(1):6.[Abstract][Full Text]
72. Downey J, McKinney M. The psychiatric status of females presenting for infertility evaluation. Am J Orthopsychiatry. 1992 Apr;62(2):196-205.[Abstract]
73. Cousinea TM, Green TC, Corsini EA, et al. Development and validation of the Infertility Self-Efficacy Scale. Fertil Steril. 2006 Jun;85(6):1684-96.[Abstract]
74. Hjollund NH, Jensen TK, Bonde JP, et al. Distress and reduced fertility: a follow-up study of first-pregnancy planners. Fertil Steril. 1999 Jul;72(1):47-53.[Abstract]
75. European Society of Human Reproduction and Embryology. Guideline on the management of recurrent pregnancy loss. Feb 2023 [internet publication].[Full Text]
76. Bayu D, Egata G, Kefale B, et al. Determinants of infertility among married women attending Dessie Referral Hospital and Dr. Misganaw Gynecology and Obstetrics Clinic, Dessie, Ethiopia. Int J Reprod Med. 2020;2020:1540318.[Abstract][Full Text]
77. Pourghazi F, Eslami M, Mohammadi S, et al. Association between childhood obesity and infertility in later life: a systematic review of cohort studies. BMC Endocr Disord. 2023 Oct 24;23(1):235.[Abstract][Full Text]
78. van Santen HM, van de Wetering MD, Bos AME, et al. Reproductive complications in childhood cancer survivors. Pediatr Clin North Am. 2020 Dec;67(6):1187-202.[Abstract][Full Text]
79. Stuenkel CA, Gompel A. Primary ovarian insufficiency. N Engl J Med. 2023 Jan 12;388(2):154-63.[Abstract]
80. Practice Committee of the American Society for Reproductive Medicine. Fertility evaluation of infertile women: a committee opinion. Fertil Steril. 2021 Nov;116(5):1255-65.[Abstract][Full Text]
81. Younis JS, Iskander R, Fauser BCJM, et al. Does an association exist between menstrual cycle length within the normal range and ovarian reserve biomarkers during the reproductive years? A systematic review and meta-analysis. Hum Reprod Update. 2020 Nov 1;26(6):904-28.[Abstract][Full Text]
82. Eichener SF, Timpe EM. Urinary-based ovulation and pregnancy: point-of-care testing. Ann Pharmacother. 2004 Feb;38(2):325-31.[Abstract]
83. Coutifaris C, Myers ER, Guzick DS, et al. Histological dating of timed endometrial biopsy tissue is not related to fertility status. Fertil Steril. 2004 Nov;82(5):1264-72.[Abstract]
84. American Society for Reproductive Medicine. Ten things physicians and patients should question. Choosing Wisely, an initiative of the ABIM Foundation. 2022 [internet publication].[Full Text]
85. Pellerito JS, McCarthy SM, Doyle MB, et al. Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal sonography, and hysterosalpingography. Radiology. 1992 Jun;183(3):795-800.[Abstract]
86. Olpin JD, Heilbrun M. Imaging of Mullerian duct anomalies. Clin Obstet Gynecol. 2009 Mar;52(1):40-56.[Abstract]
87. Saravelos SH, Jayaprakasan K, Ojha K, et al. Assessment of the uterus with three-dimensional ultrasound in women undergoing ART. Hum Reprod Update. 2017 Mar 1;23(2):188-210.[Abstract][Full Text]
88. Ergenoglu AM, Sahin Ç, Şimşek D, et al. Comparison of three-dimensional ultrasound and magnetic resonance imaging diagnosis in surgically proven Müllerian duct anomaly cases. Eur J Obstet Gynecol Reprod Biol. 2016 Feb;197:22-6.[Abstract]
89. Broeze KA, Opmeer BC, Van Geloven N, et al. Are patient characteristics associated with the accuracy of hysterosalpingography in diagnosing tubal pathology? An individual patient data meta-analysis. Hum Reprod Update. 2011 May-Jun;17(3):293-300.[Abstract]
90. Saunders RD, Shwayder JM, Nakajima ST. Current methods of tubal patency assessment. Fertil Steril. 2011 Jun;95(7):2171-9.[Abstract]
91. Qu E, Zhang M, Ju J, et al. Is hysterosalpingo-contrast sonography (HyCoSy) using sulfur hexafluoride microbubbles (SonoVue) sufficient for the assessment of fallopian tube patency? A systematic review and meta-analysis. J Ultrasound Med. 2023 Jan;42(1):7-15.[Abstract]
92. Glanville EJ, Venetis C, Boothroyd CA, et al. The use of oil-soluble contrast media for tubal flushing in infertility: a consensus statement from ACCEPT (Australasian CREI Consensus Expert Panel on Trial evidence). Aust N Z J Obstet Gynaecol. 2020 Oct;60(5):667-70.[Abstract][Full Text]
93. Wang R, Watson A, Johnson N, et al. Tubal flushing for subfertility. Cochrane Database Syst Rev. 2020 Oct 15;(10):CD003718.[Abstract][Full Text]
94. Roest I, Rosielle K, van Welie N, et al. Safety of oil-based contrast medium for hysterosalpingography: a systematic review. Reprod Biomed Online. 2021 Jun;42(6):1119-29.[Abstract][Full Text]
95. Sylvestre C, Child TJ, Tulandi T, et al. A prospective study to evaluate the efficacy of two- and three-dimensional sonohysterography in women with intrauterine lesions. Fertil Steril. 2003 May;79(5):1222-5.
96. Nieuwenhuis LL, Hermans FJ, Bij de Vaate AJM, et al. Three-dimensional saline infusion sonography compared to two-dimensional saline infusion sonography for the diagnosis of focal intracavitary lesions. Cochrane Database Syst Rev. 2017 May 5;5:CD011126.[Abstract][Full Text]
97. Vitale SG, Carugno J, Riemma G, et al. Hysteroscopy for assessing fallopian tubal obstruction: a systematic review and diagnostic test accuracy meta-analysis. J Minim Invasive Gynecol. 2021 Apr;28(4):769-78.[Abstract]
98. Hou JH, Lu BJ, Huang YL, et al. Outpatient hysteroscopy impact on subsequent assisted reproductive technology: a systematic review and meta-analysis in patients with normal transvaginal sonography or hysterosalpingography images. Reprod Biol Endocrinol. 2024 Feb 1;22(1):18.[Abstract][Full Text]
99. Vitale SG, Angioni S, Parry JP, et al. Efficacy of hysteroscopy in improving fertility outcomes in women undergoing assisted reproductive technique: a systematic review and meta-analysis of randomized controlled trials. Gynecol Obstet Invest. 2023;88(6):336-48.[Abstract][Full Text]
100. Kamath MS, Bosteels J, D'Hooghe TM, et al. Screening hysteroscopy in subfertile women and women undergoing assisted reproduction. Cochrane Database Syst Rev. 2019 Apr 16;4(4):CD012856.[Abstract][Full Text]
101. Domingues TS, Rocha AM, Serafini PC. Tests for ovarian reserve: reliability and utility. Curr Opinion Obstet Gynecol. 2010 Aug;22(4):271-6.[Abstract]
102. La Marca A, Sighinolfi G, Radi D, et al. Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Hum Reprod Update. 2010 Mar-Apr;16(2):113-30.[Abstract][Full Text]
103. Maheshwari A, Bhattacharya S, Johnson NP. Predicting fertility. Hum Fertil (Camb). 2008 Jun;11(2):109-17.[Abstract]
104. Broekmans FJ, Kwee J, Hendriks DJ, et al. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update. 2006 Nov-Dec;12(6):685-718.[Abstract][Full Text]
105. American Society for Reproductive Medicine. Definition of infertility: a committee opinion. 2023 [internet publication].[Full Text]
106. Practice Committee of the American Society for Reproductive Medicine. Evidence-based diagnosis and treatment for uterine septum: a guideline. Fertil Steril. 2024 Aug;122(2):251-65.[Abstract][Full Text]
107. Bougie O, Randle E, Thurston J, et al. Guideline no. 447: diagnosis and management of endometrial polyps. J Obstet Gynaecol Can. 2024 Mar;46(3):102402.[Abstract]
108. Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. J Clin Endocrinol Metab. 2023 Sep 18;108(10):2447-69.[Abstract][Full Text]
109. Liu KE, Case A. No. 346 - advanced reproductive age and fertility. J Obstet Gynaecol Can. 2017 Aug;39(8):685-95.[Abstract]
110. ESHRE PGT Consortium and SIG-Embryology Biopsy Working Group, Kokkali G, Coticchio G, et al. ESHRE PGT Consortium and SIG Embryology good practice recommendations for polar body and embryo biopsy for PGT. Hum Reprod Open. 2020;2020(3):hoaa020.[Abstract][Full Text]
111. Poppe K, Bisschop P, Fugazzola L, et al. 2021 European Thyroid Association guideline on thyroid disorders prior to and during assisted reproduction. Eur Thyroid J. 2021 Feb;9(6):281-95.[Abstract][Full Text]
112. Balen AH, Anderson RA; Policy & Practice Committee of the BFS. Impact of obesity on female reproductive health: British Fertility Society Practice and Policy Guidelines. Hum Fertil (Camb). 2007 Dec;10(4):195-206.[Abstract]
113. Nieuwenhuis-Ruifrok AE, Kuchenbecker WK, Hoek A, et al. Insulin sensitizing drugs for weight loss in women of reproductive age who are overweight or obese: systematic review and meta-analysis. Hum Reprod Update. 2009 Jan-Feb;15(1):57-68.[Abstract][Full Text]
114. Boedt T, Vanhove AC, Vercoe MA, et al. Preconception lifestyle advice for people with infertility. Cochrane Database Syst Rev. 2021 Apr 29;(4):CD008189.[Abstract][Full Text]
115. Jeong HG, Cho S, Ryu KJ, et al. Effect of weight loss before in vitro fertilization in women with obesity or overweight and infertility: a systematic review and meta-analysis. Sci Rep. 2024 Mar 14;14(1):6153.[Abstract][Full Text]
116. Cousineau T, Domar A. Psychological impact of infertility. Best Pract Res Clin Obstet Gynaecol. 2007 Apr;21(2):293-308.[Abstract]
117. Warne E, Oxlad M, Best T. Evaluating group psychological interventions for mental health in women with infertility undertaking fertility treatment: a systematic review and meta-analysis. Health Psychol Rev. 2023 Sep;17(3):377-401.[Abstract]
118. Verkuijlen J, Verhaak C, Nelen WL, et al. Psychological and educational interventions for subfertile men and women. Cochrane Database Syst Rev. 2016 Mar 31;3:CD011034.[Abstract][Full Text]
119. Pritts EA. Letrozole for ovulation induction and controlled ovarian hyperstimulation. Curr Opin Obstet Gynecol. 2010 Aug;22(4):289-94.[Abstract]
120. Polyzos NP, Tzioras S, Badawy AM, et al. Aromatase inhibitors for female infertility: a systematic review of the literature. Reprod Biomed Online. 2009 Oct;19(4):456-71.[Abstract]
121. He D, Jiang F. Meta-analysis of letrozole versus clomiphene citrate in polycystic ovary syndrome. Reprod Biomed Online. 2011 Jul;23(1):91-6.[Abstract][Full Text]
122. Usluogullari B, Duvan C, Usluogullari C. Use of aromatase inhibitors in practice of gynecology. J Ovarian Res. 2015 Feb 25;8:4.[Abstract][Full Text]
123. Seyedoshohadaei F, Tangestani L, Zandvakili F, et al. Comparison of the effect of clomiphene-estradiol valerate vs letrozole on endometrial thickness, abortion and pregnancy rate in infertile women with polycystic ovarian syndrome. J Clin Diagn Res. 2016 Aug;10(8):QC10-3.[Abstract][Full Text]
124. Wang R, Kim BV, van Wely M, et al. Treatment strategies for women with WHO group II anovulation: systematic review and network meta-analysis. BMJ. 2017 Jan 31;356:j138.[Abstract][Full Text]
125. Pundir J, Achilli C, Bhide P, et al. Risk of foetal harm with letrozole use in fertility treatment: a systematic review and meta-analysis. Hum Reprod Update. 2021 Apr 21;27(3):474-85.[Abstract][Full Text]
126. van Wely M, Kwan I, Burt AL, et al. Recombinant versus urinary gonadotrophin for ovarian stimulation in assisted reproductive technology cycles. Cochrane Database Syst Rev. 2011 Feb 16;(2):CD005354.[Abstract]
127. van Rumste MME, Custers IM, van der Veen et al. The influence of the number of follicles on pregnancy rates in intrauterine insemination with ovarian stimulation: a meta-analysis. Hum Reprod Update. 2008 Nov-Dec;14(6):563-70.[Abstract][Full Text]
128. Smithson DS, Vause TDR, Cheung AP. No. 362-Ovulation induction in polycystic ovary syndrome. J Obstet Gynaecol Can. 2018 Jul;40(7):978-87.[Abstract][Full Text]
129. Wang R, Li W, Bordewijk EM, et al. First-line ovulation induction for polycystic ovary syndrome: an individual participant data meta-analysis. Hum Reprod Update. 2019 Nov 5;25(6):717-32.[Abstract][Full Text]
130. Liu Z, Geng Y, Huang Y, et al. Letrozole compared with clomiphene citrate for polycystic ovarian syndrome: a systematic review and meta-analysis. Obstet Gynecol. 2023 Mar 1;141(3):523-34.[Abstract]
131. Franik S, Le Q-K, Kremer JAM, et al. Aromatase inhibitors (letrozole) for ovulation induction in infertile women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2022 Sep 27;9:CD010287.[Abstract][Full Text]
132. Sharpe A, Morley LC, Tang T, et al. Metformin for ovulation induction (excluding gonadotrophins) in women with polycystic ovary syndrome. Cochrane Database Syst Rev. 2019 Dec 17;12(12):CD013505.[Abstract][Full Text]
133. Royal College of Obstetricians & Gynaecologists. Metformin therapy for the management of infertility in women with polycystic ovary syndrome: scientific impact paper No. 13. BJOG. 2017 Nov;124(12):e306-13.[Abstract][Full Text]
134. Morley LC, Tang T, Yasmin E, et al. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev. 2017 Nov 29;11:CD003053[Abstract][Full Text]
135. Bordewijk EM, Ng KYB, Rakic L, et al. Laparoscopic ovarian drilling for ovulation induction in women with anovulatory polycystic ovary syndrome. Cochrane Database Syst Rev. 2020 Feb 11;2:CD001122.[Abstract][Full Text]
136. Fernandez H, Morin-Surruca M, Torre A, et al. Ovarian drilling for surgical treatment of polycystic ovarian syndrome: a comprehensive review. Reprod Biomed Online. 2011 Jun;22(6):556-68.[Abstract][Full Text]
137. Zhang J, Zhou K, Luo X, et al. Variation of laparoscopic ovarian drilling for clomiphene citrate-resistant patients with polycystic ovary syndrome and infertility: a meta-analysis. J Minim Invasive Gynecol. 2020 Jul-Aug;27(5):1048-58.[Abstract]
138. Tang K, Wu L, Luo Y, et al. In vitro fertilization outcomes in women with polycystic ovary syndrome: a meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2021 Apr;259:146-52.[Abstract]
139. Practice Committee of the American Society for Reproductive Medicine. Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertil Steril. 2024 Feb;121(2):230-45.[Abstract][Full Text]
140. Zaat T, Zagers M, Mol F, et al. Fresh versus frozen embryo transfers in assisted reproduction. Cochrane Database Syst Rev. 2021 Feb 4;2(2):CD011184.[Abstract][Full Text]
141. Chua SJ, Akande VA, Mol BW. Surgery for tubal infertility. Cochrane Database Syst Rev. 2017 Jan 23;1:CD006415.[Abstract][Full Text]
142. Ahmad G, Watson A, Vanderkerchove P, et al. Techniques for pelvic surgery in subfertility. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD000221.[Abstract]
143. Melo P, Georgiou EX, Johnson N, et al. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database Syst Rev. 2020 Oct 22;10(10):CD002125.[Abstract][Full Text]
144. Buckett W, Sierra S. The management of unexplained infertility: an evidence-based guideline from the Canadian Fertility and Andrology Society. Reprod Biomed Online. 2019 Oct;39(4):633-40.[Abstract][Full Text]
145. Marcoux S, Maheux R, Bérubé S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med. 1997 Jul 24;337(4):217-22.[Abstract][Full Text]
146. Bafort C, Beebeejaun Y, Tomassetti C, et al. Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev. 2020 Oct 23;10(10):CD011031.[Abstract][Full Text]
147. European Society of Human Reproduction and Embryology. ESHRE guideline endometriosis. Feb 2022 [internet publication].[Full Text]
148. Vesali S, Razavi M, Rezaeinejad M, et al. Endometriosis fertility index for predicting non-assisted reproductive technology pregnancy after endometriosis surgery: a systematic review and meta-analysis. BJOG. 2020 Jun;127(7):800-809.[Abstract]
149. Hughes E, Brown J, Collins JJ, et al. Ovulation suppression for endometriosis for women with subfertility. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD000155.[Abstract][Full Text]
150. Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril. 2012 Sep;98(3):591-8.[Abstract][Full Text]
151. Benschop L, Farquhar C, van der Poel N, et al. Interventions for women with endometrioma prior to assisted reproductive technology. Cochrane Database Syst Rev. 2010 Nov 10;(11):CD008571.[Abstract][Full Text]
152. Bourdon M, Peigné M, Maignien C, et al. Impact of endometriosis surgery on in vitro fertilization/intracytoplasmic sperm injection outcomes: a systematic review and meta-analysis. Reprod Sci. 2024 Jun;31(6):1431-55.[Abstract]
153. Liang Y, Liu M, Zhang J, et al. First-line surgery versus first-line assisted reproductive technology for women with deep infiltrating endometriosis: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2024 Apr 18;15:1352770.[Abstract][Full Text]
154. Latif S, Khanjani S, Saridogan E. Endometriosis and in vitro fertilization. Medicina (Kaunas). 2024 Aug 21;60(8):1358.[Abstract][Full Text]
155. Wang XL, Xu ZW, Huang YY, et al. Different subtypes of ultrasound-diagnosed adenomyosis and in vitro fertilization outcomes: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2023 Jun;102(6):657-68.[Abstract][Full Text]
156. Dason ES, Maxim M, Sanders A, et al. Guideline no. 437: diagnosis and management of adenomyosis. J Obstet Gynaecol Can. 2023 Jun;45(6):417-29.[Abstract]
157. Pados G, Gordts S, Sorrentino F, et al. Adenomyosis and infertility: a literature review. Medicina (Kaunas). 2023 Aug 26;59(9):1551.[Abstract][Full Text]
158. Nirgianakis K, Kalaitzopoulos DR, Schwartz ASK, et al. Fertility, pregnancy and neonatal outcomes of patients with adenomyosis: a systematic review and meta-analysis. Reprod Biomed Online. 2021 Jan;42(1):185-206.[Abstract][Full Text]
159. Jiang L, Han Y, Song Z, et al. Pregnancy outcomes after uterus-sparing operative treatment for adenomyosis: a systematic review and meta-analysis. J Minim Invasive Gynecol. 2023 Jul;30(7):543-54.[Abstract]
160. Cozzolino M, Tartaglia S, Pellegrini L, et al. The effect of uterine adenomyosis on IVF outcomes: a systematic review and meta-analysis. Reprod Sci. 2022 Nov;29(11):3177-93.[Abstract]
161. Human Fertilisation and Embryology Authority (HFEA). Fertility treatment 2018. Trends and figures. Jun 2020 [internet publication].[Full Text]
162. Jones BP, Ranaei-Zamani N, Vali S, et al. Options for acquiring motherhood in absolute uterine factor infertility; adoption, surrogacy and uterine transplantation. Obstet Gynaecol. 2021 Apr;23(2):138-47.[Abstract][Full Text]
163. Herlin MK, Petersen MB, Brännström M. Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome: a comprehensive update. Orphanet J Rare Dis. 2020 Aug 20;15(1):214.[Abstract][Full Text]
164. Jee BC, Jeong HG. Management of endometrial polyps in infertile women: a mini-review. Clin Exp Reprod Med. 2021 Sep;48(3):198-202.[Abstract][Full Text]
165. Bosteels J, van Wessel S, Weyers S, et al. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database Syst Rev. 2018 Dec 5;12(12):CD009461.[Abstract][Full Text]
166. Motan T, Cockwell H, Elliott J, et al. Guideline no. 446: hysteroscopic surgery in fertility therapy. J Obstet Gynaecol Can. 2024 Feb;46(2):102400.[Abstract]
167. National Institute for Health and Care Excellence. Hysteroscopic metroplasty of a uterine septum for primary infertility. Jan 2015 [internet publication].[Full Text]
168. Alvero R, Burney RO, Khorshid A, et al. Surgical treatment of uterine septum to improve reproductive outcomes - resect or not? Fertil Steril. 2021 Aug;116(2):298-305.[Abstract][Full Text]
169. Noventa M, Spagnol G, Marchetti M, et al. Uterine septum with or without hysteroscopic metroplasty: impact on fertility and obstetrical outcomes - a systematic review and meta-analysis of observational research. J Clin Med. 2022 Jun 8;11(12):3290.[Abstract][Full Text]
170. Rikken JFW, Kowalik CR, Emanuel MH, et al. Septum resection versus expectant management in women with a septate uterus: an international multicentre open-label randomized controlled trial. Hum Reprod. 2021 Apr 20;36(5):1260-7.[Abstract][Full Text]
171. Practice Committee of the American Society for Reproductive Medicine. Evidence-based treatments for couples with unexplained infertility: a guideline. Fertil Steril. 2020 Feb;113(2):305-22.[Abstract][Full Text]
172. Practice Committee of the Society for Reproductive Endocrinology and Infertility, Quality Assurance Committee of the Society for Assisted Reproductive Technology, and the Practice Committee of the American Society for Reproductive Medicine. Multiple gestation associated with infertility therapy: a committee opinion. Fertil Steril. 2022 Mar;117(3):498-511.[Abstract][Full Text]
173. ESHRE Guideline Group on the Number of Embryos to Transfer; Alteri A, Arroyo G, Baccino G, et al. ESHRE guideline: number of embryos to transfer during IVF/ICSI. Hum Reprod. 2024 Apr 3;39(4):647-57.[Abstract][Full Text]
174. Rodriguez-Wallberg KA, Palomares AR, Nilsson HP, et al. Obstetric and perinatal outcomes of singleton births following single- vs double-embryo transfer in Sweden. JAMA Pediatr. 2023 Feb 1;177(2):149-59.[Abstract][Full Text]
175. Centers for Disease Control and Prevention. Assisted reproductive technology (ART) data [internet publication].[Full Text]
176. European IVF Monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology (ESHRE); Smeenk J, Wyns C, De Geyter C, et al. ART in Europe, 2019: results generated from European registries by ESHRE. Hum Reprod. 2023 Dec 4;38(12):2321-38.[Abstract][Full Text]
177. Human Fertilisation and Embryology Authority (HFEA). Fertility treatment 2021. Preliminary trends and figures. Jun 2023 [internet publication].[Full Text]
178. Wessel JA, Danhof NA, van Eekelen R, et al. Ovarian stimulation strategies for intrauterine insemination in couples with unexplained infertility: a systematic review and individual participant data meta-analysis. Hum Reprod Update. 2022 Aug 25;28(5):733-46.[Abstract][Full Text]
179. Practice Committee of the American Society for Reproductive Medicine. Evidence-based outcomes after oocyte cryopreservation for donor oocyte in vitro fertilization and planned oocyte cryopreservation: a guideline. Fertil Steril. 2021 Jul;116(1):36-47.[Abstract][Full Text]
180. Cobo A, Meseguer M, Remohí J, et al. Use of cryo-banked oocytes in an ovum donation programme: a prospective, randomized, controlled, clinical trial. Hum Reprod. 2010 Sep;25(9):2239-46.[Abstract][Full Text]
181. Cobo A, García-Velasco J, Domingo J, et al. Elective and Onco-fertility preservation: factors related to IVF outcomes. Hum Reprod. 2018 Dec 1;33(12):2222-31.[Abstract][Full Text]
182. Munné S, Kaplan B, Frattarelli JL, et al. Preimplantation genetic testing for aneuploidy versus morphology as selection criteria for single frozen-thawed embryo transfer in good-prognosis patients: a multicenter randomized clinical trial. Fertil Steril. 2019 Dec;112(6):1071-79.e7.[Abstract][Full Text]
183. Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology. The use of preimplantation genetic testing for aneuploidy: a committee opinion. Fertil Steril. 2024 Sep;122(3):421-34.[Abstract]
184. Brännström M, Johannesson L, Bokström H, et al. Livebirth after uterus transplantation. Lancet. 2015 Feb 14;385(9968):607-16.[Abstract]
185. Brännström M, Belfort MA, Ayoubi JM. Uterus transplantation worldwide: clinical activities and outcomes. Curr Opin Organ Transplant. 2021 Dec 1;26(6):616-26.[Abstract]
186. Éliás M, Kónya M, Kekk Z, et al. Platelet-rich plasma (PRP) treatment of the ovaries significantly improves fertility parameters and reproductive outcomes in diminished ovarian reserve patients: a systematic review and meta-analysis. J Ovarian Res. 2024 May 17;17(1):104.[Abstract][Full Text]
187. Vahabi Dastjerdi M, Sheibani S, Taheri M, et al. Efficacy of intra-ovarian injection of autologous platelet-rich plasma in women with poor responders: a systematic review and meta-analysis. Arch Gynecol Obstet. 2024 Jun;309(6):2323-38.[Abstract]
188. Yang P, Wu R, Zhang H. The effect of growth hormone supplementation in poor ovarian responders undergoing IVF or ICSI: a meta-analysis of randomized controlled trials. Reprod Biol Endocrinol. 2020 Jul 29;18(1):76.[Abstract][Full Text]
189. Lin G, Zhong X, Li S, et al. Clinical evidence of growth hormone for infertile women with diminished ovarian reserve undergoing IVF: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2023 Nov 7;14:1215755.[Abstract][Full Text]
190. Zhang Y, Zhang C, Shu J, et al. Adjuvant treatment strategies in ovarian stimulation for poor responders undergoing IVF: a systematic review and network meta-analysis. Hum Reprod Update. 2020 Feb 28;26(2):247-63.[Abstract][Full Text]
191. Glujovsky D, Pesce R, Miguens M, et al. How effective are the non-conventional ovarian stimulation protocols in ART? A systematic review and meta-analysis. J Assist Reprod Genet. 2020 Dec;37(12):2913-28.[Abstract][Full Text]
192. Guan S, Feng Y, Huang Y, et al. Progestin-primed ovarian stimulation protocol for patients in assisted reproductive technology: a meta-analysis of randomized controlled trials. Front Endocrinol (Lausanne). 2021 Aug 31;12:702558.[Abstract][Full Text]
193. European Society of Human Reproduction and Embryology. Ovarian stimulation for IVF/ICS. Oct 2019 [internet publication].[Full Text]
194. Jiang D, Li L, Zeng BY. Treatment of Chinese herbal medicine for female infertility. Int Rev Neurobiol. 2017;135:233-47.[Abstract]
195. Hyun JY, Jung HS, Park JY. Herbal therapeutics for female infertility: a systematic review and meta-analysis. J Ethnopharmacol. 2024 Jan 30;319(pt 2):117258.[Abstract]
196. Practice Committee of the American Society for Reproductive Medicine and the Practice Committee for the Society for Assisted Reproductive Technologies. Guidance on the limits to the number of embryos to transfer: a committee opinion. Fertil Steril. 2021 Sep;116(3):651-4.[Abstract][Full Text]
197. Hull MG, Glazener CM, Kelly NJ, et al. Population study of causes, treatment, and outcome of infertility. Br Med J (Clin Res Ed). 1985 Dec 14;291(6510):1693-7.[Abstract]
198. Homburg R. Clomiphene citrate - end of an era? A mini-review. Hum Reprod. 2005 Aug;20(8):2043-51.[Abstract][Full Text]
199. Dickey RP. Strategies to reduce multiple pregnancies due to ovulation stimulation. Fertil Steril. 2009 Jan;91(1):1-17.[Abstract]
200. Royal College of Obstetricians and Gynaecologists. The management of ovarian hyperstimulation syndrome: green-top guideline no. 5. Feb 2016 [internet publication].[Full Text]
201. Shmorgun D, Claman P. No-268: the diagnosis and management of ovarian hyperstimulation syndrome. J Obstet Gynaecol Can. 2017 Nov;39(11):e479-86.[Abstract]
202. Zivi E, Simon A, Laufer N. Ovarian hyperstimulation syndrome: definition, incidence, and classification. Semin Reprod Med. 2010 Nov;28(6):441-7.[Abstract]
203. Royal College of Obstetricians and Gynaecologists. Multiple pregnancies following assisted conception: scientific impact paper no. 22. BJOG. 2018 Apr;125(5):e12-8.[Abstract][Full Text]
204. American College of Obstetricians and Gynecologists. Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies: ACOG practice bulletin, number 231. Obstet Gynecol. 2021 Jun 1;137(6):e145-62.[Abstract]
205. Muller V, Makhmadalieva M, Kogan I, et al. Ectopic pregnancy following in vitro fertilization: meta-analysis and single-center experience during 6 years. Gynecol Endocrinol. 2016 Oct;32(sup2):69-74.[Abstract][Full Text]
206. Wang Y, Chen L, Tao Y, et al. Risk factors of ectopic pregnancy after in vitro fertilization-embryo transfer in Chinese population: a meta-analysis. PLoS One. 2024 Jan 2;19(1):e0296497.[Abstract][Full Text]
207. Perkins KM, Boulet SL, Kissin DM, et al. Risk of ectopic pregnancy associated with assisted reproductive technology in the United States, 2001-2011. Obstet Gynecol. 2015 Jan;125(1):70-8.[Abstract][Full Text]
208. American College of Obstetricians and Gynecologists' Committee on Obstetric Practice; Committee on Genetics; U.S. Food and Drug Administration. Committee opinion no 671: perinatal risks associated with assisted reproductive technology. Obstet Gynecol. 2016 Sep;128(3):e61-8.[Abstract][Full Text]
209. Qin J, Sheng X, Wang H, et al. Assisted reproductive technology and risk of congenital malformations: a meta-analysis based on cohort studies. Arch Gynecol Obstet. 2015 Oct;292(4):777-98.[Abstract]
210. Venetis C, Choi SKY, Jorm L, et al. Risk for congenital anomalies in children conceived with medically assisted fertility treatment: a population-based cohort study. Ann Intern Med. 2023 Oct;176(10):1308-20.[Abstract]
211. Rizzuto I, Behrens RF, Smith LA. Risk of ovarian cancer in women treated with ovarian stimulating drugs for infertility. Cochrane Database Syst Rev. 2019 Jun 18;6(6):CD008215.[Abstract][Full Text]
212. Yu L, Sun J, Wang Q, et al. Ovulation induction drug and ovarian cancer: an updated systematic review and meta-analysis. J Ovarian Res. 2023 Jan 24;16(1):22.[Abstract][Full Text]
213. Practice Committee of the American Society for Reproductive Medicine. Fertility drugs and cancer: a guideline. Fertil Steril. 2024 Sep;122(3):406-20.[Abstract][Full Text]
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