Evidence-Based Care for Couples With Infertility


      When couples cannot achieve pregnancy, they often seek health care from medical and nursing specialists. The care the couple receives begins with a thorough assessment to determine the possible cause of infertility and to plan appropriate care to ensure the best chance for the couple to have a biological child. In this article, we provide an overview of the etiology and evaluation of infertility, the various treatment options available, and the appropriate clinical implications.


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        • American Society for Reproductive Medicine
        Infertility: An overview.
        2015 (Retrieved from)
        • Bay B.
        • Mortensen E.L.
        • Kesmodel U.S.
        Assisted reproduction and child neurodevelopmental outcomes: A systematic review.
        Fertility and Sterility. 2013; 100: 844-853
        • Bensdorp A.J.
        • Slappendel E.
        • Koks C.
        • Oosterhuis J.
        • Hoek A.
        • Hompes P.
        • van Wely M.
        The INeS study: Prevention of multiple pregnancies: A randomised controlled trial comparing IUI COH versus IVF e SET versus MNC IVF in couples with unexplained or mild male subfertility.
        BMC Women's Health. 2009; 9: 1-8
        • Bergh C.M.
        • Moore M.
        • Gundell C.
        Evidence-based management of infertility in women with polycystic ovary syndrome.
        Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2016; 45: 111-122
        • Boivin J.
        • Buntin L.
        • Collins J.A.
        • Nygren K.G.
        International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care.
        Human Reproduction. 2007; 22: 1506-1512
        • Brucker P.S.
        • McKenry P.C.
        Support from health care providers and the psychological adjustment of individuals experiencing infertility.
        Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2004; 33: 597-603
        • Budev M.M.
        • Arroliga A.C.
        • Falcone T.
        Ovarian hyperstimulation syndrome.
        Critical Care Medicine. 2005; 33: S301-S306
        • Centers for Disease Control and Prevention
        Infertility services.
        Author, Atlanta, GA2014 (Retrieved from
        • Centers for Disease Control and Prevention
        ART success rates.
        Author, Atlanta, GA2015 (Retrieved from
        • Chandra A.
        • Copen C.E.
        • Stephen E.H.
        Infertility and impaired fecundity in the United States, 1982–2010: Data from the National Survey of Family Growth.
        National Health Statistics Report. 2013; 67: 1-18
        • Chen C.K.
        • Yu H.T.
        • Soong Y.K.
        • Lee C.L.
        New perspectives on preimplantation genetic diagnosis and preimplantation genetic screening.
        Taiwan Journal of Obstetrics and Gynecology. 2014; 53: 146-150
        • Child T.
        Optimising the management of patients with infertility.
        The Practitioner. 2013; 257: 19-22
        • Ciarmela P.
        • Critchley H.
        • Christman G.M.
        • Reis F.M.
        Pathogenesis of endometriosis and uterine fibroids.
        Obstetrics and Gynecology International. 2013; 2013: 656571
        • Collins J.A.
        • Burrows E.A.
        • Yeo J.
        • YoungLai E.V.
        Frequency and predictive value of antisperm antibodies among infertile couples.
        Human Reproduction. 1993; 8: 592-598
        • Crossman S.H.
        The challenge of pelvic inflammatory disease.
        American Family Physician. 2006; 73: 859-864
        • Devine K.
        • Stillman R.J.
        • DeCherney A.H.
        The Affordable Care Act: Early implications for fertility medicine.
        Fertility and Sterility. 2014; 101: 1224-1227
        • Drazba K.T.
        • Kelley M.A.
        • Hershberger P.E.
        A qualitative inquiry of the financial concerns of couples opting to use preimplantation genetic diagnosis to prevent the transmission of known genetic disorders.
        Journal of Genetic Counseling. 2014; 23: 202-211
        • El-Chaar D.
        • Yang Q.
        • Gao J.
        • Bottomley J.
        • Leader A.
        • Wen S.W.
        • Walker M.
        Risk of birth defects increased in pregnancies conceived by assisted human reproduction.
        Fertility and Sterility. 2009; 92: 1557-1561
        • Ethics Committee of the American Society for Reproductive Medicine
        Consideration of the gestational carrier: A committee opinion.
        Fertility and Sterility. 2013; 99: 1838-1841
        • Fauser B.C.
        • Devroey P.
        • Macklon N.S.
        Multiple birth resulting from ovarian stimulation for subfertility treatment.
        Lancet. 2005; 365: 1807-1816
        • Finer L.B.
        • Philbin J.M.
        Trends in ages at key reproductive transitions in the United States, 1951–2010.
        Women's Health Issues. 2014; 24: e271-e279
        • Fong S.A.
        • Palta V.
        • Oh C.
        • Cho M.M.
        • Loughlin J.S.
        • McGovern P.G.
        Multiple pregnancy after gonadotropin-intrauterine insemination: An unavoidable event?.
        ISRN Obstetrics and Gynecology. 2011; 2011: 465483
        • Forman E.J.
        • Hong K.H.
        • Franasiak J.M.
        • Scott Jr., R.T.
        Obstetrical and neonatal outcomes from the BEST Trial: Single embryo transfer with aneuploidy screening improves outcomes after in vitro fertilization without compromising delivery rates.
        American Journal of Obstetrics and Gynecology. 2014; 210: 157.e1-157.e6
        • Forman R.G.
        • Frydman R.
        • Egan D.
        • Ross C.
        • Barlow D.H.
        Severe ovarian hyperstimulation syndrome using agonists of gonadotropin-releasing hormone for in vitro fertilization: A European series and a proposal for prevention.
        Fertility and Sterility. 1990; 53: 502-509
        • Gaikwad S.
        • Garrido N.
        • Cobo A.
        • Pellicer A.
        • Remohi J.
        Bed rest after embryo transfer negatively affects in vitro fertilization: A randomized controlled clinical trial.
        Fertility and Sterility. 2013; 100: 729-735.e2
        • Gleicher N.
        • Oleske D.M.
        • Tur-Kaspa I.
        • Vidali A.
        • Karande V.
        Reducing the risk of high-order multiple pregnancy after ovarian stimulation with gonadotropins.
        New England Journal of Medicine. 2000; 343: 2-7
        • Guermandi E.
        • Vegetti W.
        • Bianchi M.M.
        • Uglietti A.
        • Ragni G.
        • Crosignani P.
        Reliability of ovulation tests in infertile women.
        Obstetrics & Gynecology. 2001; 97: 92-96
        • Hasanpour S.
        • Bani S.
        • Mirghafourvand M.
        • Yahyavi Kochaksarayie F.
        Mental health and its personal and social predictors in infertile women.
        Journal of Caring Science. 2014; 3: 37-45
        • Hotaling J.M.
        Genetics of male fertility.
        Urologic Clinics of North America. 2014; 41: 1-17
        • Hunt P.
        • Hassold T.
        Female meiosis: Coming unglued with age.
        Current Biology. 2010; 20: R699-R702
        • Jain T.
        Socioeconomic and racial disparities among infertility patients seeking care.
        Fertility and Sterility. 2006; 85: 876-881
        • Katz P.
        • Showstack J.
        • Smith J.F.
        • Nachtigall R.D.
        • Millstein S.G.
        • Adler N.
        Costs of infertility treatment: Results from an 18-month prospective cohort study.
        Fertility and Sterility. 2011; 95: 915-921
        • Kessler L.M.
        • Craig B.M.
        • Plosker S.M.
        • Reed D.R.
        • Quinn G.P.
        Infertility evaluation and treatment among women in the United States.
        Fertility and Sterility. 2013; 100: 1025-1032
        • Kohler H.P.
        • Ortega J.A.
        Tempo-adjusted period parity progression measures, fertility postponement and completed cohort fertility.
        Demographic Research. 2002; 6: 91-144
        • Kolon T.F.
        • Herndon C.D.
        • Baker L.A.
        • Baskin L.S.
        • Baxter C.G.
        • Cheng E.Y.
        • Barthold J.S.
        Evaluation and treatment of cryptorchidism: AUA guideline.
        Journal of Urology. 2014; 192: 337-345
        • Krausz C.
        Male infertility: Pathogenesis and clinical diagnosis.
        Best Practice & Research Clinical Endocrinology & Metabolism. 2011; 25: 71-85
        • Lamb D.J.
        • Lipshulz L.I.
        Male infertility: Recent advances and a look towards the future.
        Current Opinion in Urology. 2000; 10: 359-362
        • Lanzendorf S.E.
        • Maloney M.K.
        • Veeck L.L.
        • Slusser J.
        • Hodgen G.D.
        • Rosenwaks Z.
        A preclinical evaluation of pronuclear formation by microinjection of human spermatozoa into human oocytes.
        Fertility and Sterility. 1988; 49: 835-842
        • Luk B.H.
        • Loke A.Y.
        The impact of infertility on the psychological well-being, marital relationships, sexual relationships, and quality of life of couples: A systematic review.
        Journal of Sex & Marital Therapy. 2015; 41: 610-625
        • MacDougall M.J.
        • Tan S.L.
        • Jacobs H.S.
        In-vitro fertilization and the ovarian hyperstimulation syndrome.
        Human Reproduction. 1992; 7: 597-600
        • MacIndoe J.H.
        • Perry P.J.
        • Yates W.R.
        • Holman T.L.
        • Ellingrod V.L.
        • Scott S.D.
        Testosterone suppression of the HPT axis.
        Journal of Investigative Medicine. 1997; 45: 441-447
        • Mocanu E.
        • Redmond M.L.
        • Hennelly B.
        • Collins C.
        • Harrison R.
        Odds of ovarian hyperstimulation syndrome (OHSS)—time for reassessment.
        Human Fertility. 2007; 10: 175-181
        • Nnoaham K.E.
        • Hummelshoj L.
        • Webster P.
        • d'Hooghe T.
        • de Cicco Nardone F.
        • de Cicco Nardone C.
        • Zondervan K.T.
        Impact of endometriosis on quality of life and work productivity: A multicenter study across ten countries.
        Fertility and Sterility. 2011; 96: 366-373
        • Palermo G.
        • Joris H.
        • Devroey P.
        • Van Steirteghem A.C.
        Pregnancies after intracytoplasmic sperm injection of single spermatozoon into an oocyte.
        Lancet. 1992; 340: 17-18
        • Papanikolaou E.G.
        • Pozzobon C.
        • Kolibianakis E.M.
        • Camus M.
        • Tournaye H.
        • Fatemi H.M.
        Incidence and prediction of ovarian hyperstimulation syndrome in women undergoing gonadotropin-releasing hormone antagonist in vitro fertilization cycles.
        Fertility and Sterility. 2006; 85: 112-120
        • Pinborg A.
        IVF/ICSI twin pregnancy: Risks and prevention.
        Human Reproduction Update. 2005; 11: 575-593
        • Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology
        Role of assisted hatching in in vitro fertilization: A guideline.
        Fertility and Sterility. 2014; 102: 348-351
        • Reichman D.E.
        • Goldschlag D.
        • Rosenwaks Z.
        Value of antimüllerian hormone as a prognostic indicator of in vitro fertilization outcome.
        Fertility and Sterility. 2014; 101: 1012-1018
        • Repropedia
        Center for Reproductive Research at Northwestern University, Evanston, IL2015 (Retrieved from
        • Rolland M.
        • LeMoal J.
        • Wagner V.
        • Royere D.
        • DeMouzon J.
        Decline in semen concentration and morphology in a sample of 26,609 men close to general population between 1989 and 2005 in France.
        Human Reproduction. 2013; 28: 462-470
        • Schankath A.C.
        • Fasching N.
        • Urech-Ruh C.
        • Hohl M.K.
        • Kubik-Huch R.A.
        Hysterosalpingography in the workup of female infertility: Indications, technique and diagnostic findings.
        Insights Imaging. 2012; 3: 475-483
        • Schorsch M.
        • Gomez R.
        • Hahn T.
        • Hoelscher-Obermaier J.
        • Seufert R.
        • Skala C.
        Success rate of inseminations dependent on maternal age? An analysis of 4246 insemination cycles.
        Geburtshilfe Frauenkeilkd. 2013; 73: 808-811
        • Scoccia B.
        • Ryden J.
        in: Ryden J. Blumenthal P.D. Practical gynecology: A guide for the primary care physician. American College of Physicians–American Society of Internal Medicine, Philadelphia, PA2009: 461-486
        • Seifer D.
        • Naftolin F.
        Moving toward an earlier and better understanding of the perimenopause.
        Fertility and Sterility. 1998; 69: 387-388
        • Shankaran S.
        Outcomes from infancy to adulthood after assisted reproductive technology.
        Fertility and Sterility. 2014; 101: 1217-1221
        • Sidebotham M.
        Egg and sperm donation: An issue for health professionals?.
        Journal of Family Health Care. 2003; 13: 134-136
        • Sirmans S.M.
        • Pate K.A.
        Epidemiology, diagnosis, and management of polycystic ovary syndrome.
        Clinical Epidemiology. 2014; 6: 1-13
        • Small C.M.
        • Manatunga A.K.
        • Klein M.
        • Feigelson H.S.
        • Dominguez C.E.
        • McChesney R.
        • Marcus M.
        Menstrual cycle characteristics: Associations with fertility and spontaneous abortion.
        Epidemiology. 2006; 17: 52-60
        • Society for Assisted Reproductive Technology
        ART: Step-by-step guide.
        2014 (Retrieved from)
        • Soria M.
        • Pradillo G.
        • García J.
        • Ramon P.
        • Castillo A.
        • Jordana C.
        • Paricio P.
        Pregnancy predictors after intrauterine insemination: Analysis of 3012 cycles in 1201 couples.
        Journal of Reproduction and Infertility. 2012; 13: 158-166
        • Stenkeler J.A.
        • Woodfield C.A.
        • Lazarus E.
        • Hillstrom M.M.
        Female infertility: A systematic approach to radiologic imaging and diagnosis.
        Radiographics. 2009; 29: 1353-1370
        • Steward R.G.
        • Lan L.
        • Shah A.A.
        • Yeh J.S.
        • Price T.M.
        • Goldfarb J.M.
        • Muasher S.J.
        Oocyte number as a predictor for ovarian hyperstimulation syndrome and live birth: An analysis of 256,381 in vitro fertilization cycles.
        Fertility and Sterility. 2014; 101: 967-973
        • Toner J.P.
        • Seifer D.B.
        Why we may abandon basal follicle-stimulating hormone testing: A sea change in determining ovarian reserve using antimüllerian hormone.
        Fertility and Sterility. 2013; 99: 1825-1830
        • U.S. Department of Health and Human Services
        Healthy People 2020. Maternal, infant and child health.
        Author, Washington, DC2015 (Retrieved from
        • Veltman-Verhulst S.M.
        • Cohlen B.J.
        • Hughes E.
        • Heineman M.J.
        Intra-uterine insemination for unexplained subfertility.
        Cochrane Database of Systematic Reviews. 2012; 9: CD001838
        • Wald M.
        Male infertility: Causes and cures.
        Sexuality, Reproduction & Menopause. 2005; 3: 83-87
        • Werner M.D.
        • Scott R.T.
        Comprehensive chromosomal screening (CCS) dramatically reduces the age related increase in 1st trimester clinical losses, but has only minimal impact on biochemical losses.
        ASRM Abstracts. 2013; 100: S20-S21
        • Williams M.
        • Green L.
        • Roberts K.
        Exploring the needs and expectations of women presenting for hysterosalpingogram examination following a period of subfertility: A qualitative study.
        International Journal of Clinical Practice. 2010; 64: 1653-1660
        • Wu A.K.
        • Elliot P.
        • Katz P.P.
        • Smith J.F.
        Time costs of fertility care: The hidden hardship of building a family.
        Fertility and Sterility. 2013; 99: 2025-2030
        • Zegers-Hochschild F.
        • Adamson G.D.
        • de Mouzon J.
        • Ishihara O.
        • Mansour R.
        • Nygren K.
        • Vanderpoel S.
        International committee for monitoring assisted reproductive technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009.
        Fertility and Sterility. 2009; 92: 1520-1524


      Eleanor L. Stevenson, PhD, RN, is an assistant professor, Duke University School of Nursing, Durham, NC.


      Patricia E. Hershberger, PhD, MSN, RN, FNP-BC, is an associate professor in the College of Nursing and an affiliate professor in the College of Medicine, University of Illinois at Chicago, Chicago, IL.


      Paul A. Bergh, MD, is a founding partner of Reproductive Medicine Associates of New Jersey and a clinical associate professor, Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology and Reproductive Sciences, Robert Wood Johnson Medical School-UMDNJ, New Brunswick, NJ.

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