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Preconceptional considerations and counseling for the infertile couple.

pproximately 15% to 20% of couples of reproductive age have difficulty conceiving or maintaining a spontaneous pregnancy. In 2002, 1.2 million (2%) women of reproductive age reported having an infertility-related medical appointment within the previous year, and approximately 9% of women ages 18 to 44 reported receiving an infertility service at some point that included advice on infertility and/or testing and services for infertility. 1 Infertility impacts every racial and ethnic group and can cause significant emotional distress in a couple’s relationship when an anticipated pregnancy does not occur in the time period in which they expected to start a family. A period of one year of unprotected intercourse without a spontaneous conception typically defines infertility. 2 There are a number of factors that can lead to infertility. Approximately 20% of infertility is related to male factors. Female factors account for 40%, and 30% can be related to both male and female factors. Unfortunately, in 15% of cases the etiology of infertility cannot be traced to any specific cause. For healthy reproductive age couples, spontaneous pregnancy is usually achieved within six months of unprotected intercourse during the female’s fertile period. For couples less than 30 years of age, failure to achieve spontaneous pregnancy after six cycles of unprotected intercourse is classified as subfertile. 3,4 However, 50% of these couples will become pregnant within the next six cycles on their own. Being patient, eliminating stressors in professional and personal lives, and using timed intercourse and ovulation predictors will likely lead to successful conception for these couples. For the infertile couple, the cumulative probability of spontaneous conception is age-dependent and declines particularly for females in their mid-30s to early 40s. Unlike the typical pregnancy in the US that is unplanned in nearly 50% of couples, the infertile couple has made a conscious decision that they desire pregnancy and, for the most part, are thoroughly invested in optimizing the chances for a successful outcome. However, the financial and emotional burden for evaluation and treatment of the infertile couple is significant. As such, preconceptional counseling about all aspects of preconceptional and pregnancy care, including ramifications and potential outcomes, should be discussed with both partners prior to embarking upon infertility treatment. The age of the couple (the woman in particular), family history, and past and current history of medical conditions can have a direct impact on pregnancy complications and a healthy pregnancy outcome. The inability to become pregnant spontaneously is associated with many emotions including shame, guilt, anxiety, and depression. Studies suggest that as many as 40% of infertility patients suffer anxiety that may lead to major depression.