From the literature
Infertility Evaluation and Treatment.
Santoro N, Polotsky AJ.
The New England Journal of Medicine. 2025;392(11):1111-1119. doi:10.1056/NEJMcp2311150.
The paper “Infertility Evaluation and Treatment” by Nanette Santoro, M.D., and Alex J. Polotsky, M.D., published in the New England Journal of Medicine on March 12, 2025, provides a comprehensive overview of the evaluation and treatment of infertility.
The evaluation process includes a detailed menstrual history and assessment of risks for anatomical infertility, such as previous pelvic surgery or infection. Medications that are potentially hazardous for pregnancy or conception should be reviewed and replaced with appropriate alternatives. For men, a history of testicular injury or undescended testes, as well as androgenic steroid use, should be assessed. The evaluation focuses on common causes of infertility, including extremes of weight, signs and symptoms of polycystic ovary syndrome (PCOS), premature ovarian insufficiency, hyperprolactinemia, and other endocrine disturbances. It is recommended to test both partners comprehensively, as a single abnormality should not be assumed to wholly explain a couple’s infertility.
The paper also discusses the prevalence and management approaches for various causes of infertility. For example, ovulatory dysfunction, which accounts for 25% of infertility cases, can be treated with ovulation induction, resulting in a live birth rate of 35.4% per treatment cycle. PCOS, affecting 8-13% of women, can be managed with letrozole or clomiphene, with cumulative live birth rates of 27.5% and 19.1% respectively over up to five cycles. Other conditions such as diminished ovarian reserve, uterine factors, and endometriosis are also addressed with specific treatment options like IVF and surgical interventions.
The age of the female partner is highlighted as the most important predictor of live birth with both natural and assisted conception. The probability of live birth with a single cycle of in vitro fertilization (IVF) therapy exceeds the monthly fecundability of natural conception, underscoring IVF’s dominant role in fertility treatment. Male reproductive issues account for at least one-third of infertility cases and can be effectively managed with assisted conception techniques.
The paper aligns its recommendations with the guidelines published by the American Society for Reproductive Medicine (ASRM) and the European Society for Human Reproduction and Embryology (ESHRE), noting some regional differences in practice. For instance, ASRM recommends routine initial testing for ovarian reserve, while ESHRE does not recommend this approach in women with regular menses.
Overall, the paper provides a detailed and evidence-based approach to the evaluation and treatment of infertility, emphasizing the importance of a comprehensive assessment and individualized treatment plans.
From the literature
Infertility Evaluation and Treatment.
Santoro N, Polotsky AJ.
The New England Journal of Medicine. 2025;392(11):1111-1119. doi:10.1056/NEJMcp2311150.
The paper “Infertility Evaluation and Treatment” by Nanette Santoro, M.D., and Alex J. Polotsky, M.D., published in the New England Journal of Medicine on March 12, 2025, provides a comprehensive overview of the evaluation and treatment of infertility.
The evaluation process includes a detailed menstrual history and assessment of risks for anatomical infertility, such as previous pelvic surgery or infection. Medications that are potentially hazardous for pregnancy or conception should be reviewed and replaced with appropriate alternatives. For men, a history of testicular injury or undescended testes, as well as androgenic steroid use, should be assessed. The evaluation focuses on common causes of infertility, including extremes of weight, signs and symptoms of polycystic ovary syndrome (PCOS), premature ovarian insufficiency, hyperprolactinemia, and other endocrine disturbances. It is recommended to test both partners comprehensively, as a single abnormality should not be assumed to wholly explain a couple’s infertility.
The paper also discusses the prevalence and management approaches for various causes of infertility. For example, ovulatory dysfunction, which accounts for 25% of infertility cases, can be treated with ovulation induction, resulting in a live birth rate of 35.4% per treatment cycle. PCOS, affecting 8-13% of women, can be managed with letrozole or clomiphene, with cumulative live birth rates of 27.5% and 19.1% respectively over up to five cycles. Other conditions such as diminished ovarian reserve, uterine factors, and endometriosis are also addressed with specific treatment options like IVF and surgical interventions.
The age of the female partner is highlighted as the most important predictor of live birth with both natural and assisted conception. The probability of live birth with a single cycle of in vitro fertilization (IVF) therapy exceeds the monthly fecundability of natural conception, underscoring IVF’s dominant role in fertility treatment. Male reproductive issues account for at least one-third of infertility cases and can be effectively managed with assisted conception techniques.
The paper aligns its recommendations with the guidelines published by the American Society for Reproductive Medicine (ASRM) and the European Society for Human Reproduction and Embryology (ESHRE), noting some regional differences in practice. For instance, ASRM recommends routine initial testing for ovarian reserve, while ESHRE does not recommend this approach in women with regular menses.
Overall, the paper provides a detailed and evidence-based approach to the evaluation and treatment of infertility, emphasizing the importance of a comprehensive assessment and individualized treatment plans.
biweekly insights
