Intended for healthcare professionals

Clinical Review

Management of infertility

BMJ 2007; 335 doi: (Published 20 September 2007) Cite this as: BMJ 2007;335:608
  1. Adam H Balen, professor of reproductive medicine and surgery,
  2. Anthony J Rutherford, consultant in reproductive medicine and surgery
  1. Leeds General Infirmary, Leeds LS2 9NS
  1. Correspondence to: A H Balen adam.balen{at}

Summary points

  • Around 9% of couples are affected by infertility and half of them seek help

  • The most important determinant of a couple's fertility is the woman's age

  • Demographic trends to delay childbearing mean that more older women are having problems trying to conceive

  • Lifestyle has a profound effect on fertility—obesity, smoking, alcohol, and recreational drugs negatively affect the chance of conception and pregnancy outcome

  • Male infertility may be increasing, possibly because of environmental pollution

  • Success rates of in vitro fertilisation may improve with a better understanding of embryo physiology

Around 9% of couples are involuntarily childless. At least a quarter of couples experience unexpected delays in achieving their desired family size,1 although only a half seek treatment. In recent years, publicity about infertility treatments has increased, and couples are now more willing to seek advice. The first of these two brief reviews covers the main causes of infertility, with particular reference to advances in the past five years; the second review will look at polycystic ovary syndrome and anovulatory infertility.

The role of the general practitioner is to initiate the investigation of both partners and ensure timely onward referral to a specialist clinic. Treatments for infertility are never far from the public eye, often courting controversy and ethical dilemmas. This article aims to provide general practitioners with a balanced and evidence based overview of the latest advances and where they fit into current practice.

Sources and selection criteria

We referred to the Cochrane database of systematic reviews, NICE guidelines for the investigation and management of infertility (2004), and our knowledge of the current literature.

Ongoing research questions and projects

  • How can we increase the success rate of assisted conception while minimising the risks of multiple pregnancy by the transfer of single embryos?

  • How can fertility be preserved in the context of cancer treatments that cause sterility or as insurance …

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