Background

Infertility affects one in seven couples during their lifetime and has an annual incidence of one couple per 1000 total population, which means that each general practitioner (GP) will see on average one to two couples with infertility each year.1 Over 80% of couples in the general population will conceive within 1 year of regular unprotected sexual intercourse (UPSI) if the woman is less than 40 years of age.2 Thereafter, clinical investigation should be offered. The main causes of infertility are male factor problems (30%), disorders of ovulation (25%), tubal problems (20%), unexplained infertility (25%) and uterine or peritoneal disorders (10%).

What's new in CG156? Key messages

A woman's age should be used as an initial predictor of her overall chance of success through natural conception or with in vitro fertilisation (IVF). In women considering IVF treatment, ovarian reserve testing is useful to predict the likely ovarian response to stimulation. This can be performed by an antral follicle count by scan, serum anti-Müllerian hormone or early follicular phase serum follicle-stimulating hormone.

The updated guideline clearly states that investigation should be offered after 1 year of regular UPSI. Early referral to an infertility specialist is recommended for any woman aged ≥36 years and for any couple where a clinical cause has been identified or there is a history of predisposing factors for infertility.

Where a cause is not identified, the threshold for access to IVF treatment for women with unexplained infertility has been reduced from 3 years to 2 years of regular UPSI, and a clear statement that clomifene citrate does not increase the chance of pregnancy or a live birth in this cohort. Moreover, intrauterine insemination with or without ovarian stimulation is not routinely recommended.

For women with World Health Organization (WHO) Group II anovulatory infertility, clomifene, metformin or a combination of these agents can be offered. Women who receive …