PRIMEVIEW

FEMALE SUBFERTILITY
For the Primer, visit doi:10.1038/s41572-018-0058-8

Infectious Uterine
Subfertility (also known as infertility) diseases (such DIAGNOSIS
MECHANISMS abnormalities
KUEQOOQPCPFCHHGEVUKP|EQWRNGU as gonorrhoea, such as fibroids,
The World Health Organization definition chlamydia and HIV) polyps or adenomyosis
Couples are usually investigated for causes of
of female subfertility is the failure and endometriosis reduce the chance of
Pregnancy requires subfertility after >12 months of unprotected
VQCEJKGXGCENKPKECNRTGIPCPE[CHVGT can lead to tubal ongoing pregnancy, but
normal follicular intercourse and failure to conceive. Typically,
|OQPVJUQHWPRTQVGEVGFTGIWNCTUGZWCN abnormalities whether they affect
development, oocyte diagnosis starts with a comprehensive assessment
KPVGTEQWTUGQTFWGVQKORCKTOGPVQHC conception is
fertilization, successful of fertility, including medical history, clinical
YQOCPoUECRCEKV[VQTGRTQFWEG unclear
uterine implantation and examination and, if indicated, specific diagnostic
development; disorders that tests. The latter can include the following:
CȭGEVCP[QHVJGUGRTQEGUUGU hysterosalpingography (HSG), hysterosalpingo
MANAGEMENT ECPECWUG|UWDHGTVKNKV[ Uterine contrast sonography (HyCoSy) and laparoscopy
abnormalities to assess the fallopian tubes; transvaginal
The chance of achieving pregnancy in women Blocked or
ultrasonography to assess the uterine cavity and
dysfunctional
with unexplained subfertility can be estimated fallopian ovaries; measurement of mid-luteal progesterone
using prognostic models. Women with a good tubes Blastocyst to assess ovulation; and measurement of
prognosis should undergo expectant management anti-Müllerian hormone, follicle-stimulating
as many couples will achieve pregnancy without hormone and/or the antral follicle count to assess
Ectopic
active treatment. The optimal time frame to stop QXCTKCP|TGUGTXG
pregnancy
expectant management and commence active
treatment (such as in vitro fertilization (IVF) or
Oocyte HSG involves the insertion
intrauterine insemination) is unknown. Women
+P|UQOG QH|CTCFKQQRCSWGF[GKPVQ
with ovulatory disorders should be offered lifestyle women, Failure to the uterine cavity and
management initially and, if unsuccessful, ovulation early menopause implant :TC[#NVJQWIJ
induction therapy. IVF is a third-line treatment. (premature ovarian used for
Women with tubal or uterine diseases (such as Ovarian Fertilization failure) can cause diagnosis,
those with adhesions, fibroids and endometriosis) dysfunction failure subfertility *5)|ECP
are often treated using surgery, with IVF as a includes altered improve
second-line therapy. Women with premature frequency or duration fertility outcomes in
ovarian failure require IVF using an oocyte donor. of the menstrual cycle, Ovarian some women, although the
and can be caused by dysfunction OGEJCPKUOUCTG|WPMPQYP
genetic conditions (such as
6WTPGT|U[PFTQOGRQN[E[UVKE
QUALITY OF LIFE ovary syndrome or other Cervical
endocrine disorders malformations
Subfertility is associated with
EPIDEMIOLOGY
emotional distress and reductions
in quality of life compared with Between 48.5 and 72.4 million couples have
population norms and women subfertility globally. Of these, ~10 million are in
with other gynaecological OUTLOOK sub-Saharan Africa and ~14 million in south Asia.
conditions. In addition, disorders Risk factors for female subfertility include older
causing subfertility and Priorities for future research individuals with subfertility and assisted reproductive technology, age, smoking and excess alcohol consumption
subfertility treatments can be include addressing the preventable encouraging new initiatives to along with efforts to improve and caffeine use, overweight, unprotected
painful, associated with stigma causes of subfertility, providing increase the global accessibility, established assisted reproductive sexual intercourse with multiple partners, stress
CPFGOQVKQPCNN[|FGOCPFKPI support and alternatives for affordability and acceptability of technology techniques. CPFGZRQUWTGVQUQOG|RGUVKEKFGU

doi:10.1038/s41572-019-0062-7; Article citation ID: (2019) 5:8 Written by Louise Adams; designed by Laura Marshall
© 2018 Springer Nature Limited. All rights reserved.