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Infertility in Males01:23

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Male infertility affects millions of couples worldwide, arising from various factors that impact different stages of the reproductive process. An endocrine imbalance resulting from conditions like hypogonadism, Klinefelter syndrome, or pituitary disorders can disrupt hormone levels and reduce sperm production. Testicular defects, such as tumors, cryptorchidism, atrophic testes, abnormal sperm morphology, and low sperm count or motility, may arise due to genetic factors, structural...
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Female infertility is defined as the inability to conceive after a year of regular, unprotected intercourse and affects about 10–15% of couples worldwide. The primary cause of female infertility is ovulatory disorders, which hinder the release of eggs. These disorders can be classified as hypothalamic amenorrhea, polycystic ovarian syndrome (PCOS), premature ovarian failure, and hyperprolactinemic anovulation disorders.
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Updated: Apr 21, 2026

Treatment Model for Young Patients with Psychogenic Erectile Dysfunction and Resultant Infertility
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Overtreatment in couples with unexplained infertility.

F A M Kersten1, R P G M Hermens2, D D M Braat1

  • 1Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, Nijmegen 6500 HB, The Netherlands.

Human Reproduction (Oxford, England)
|October 23, 2014
PubMed
Summary

Overtreatment, or starting fertility treatment too early, occurred in 36% of couples with unexplained infertility eligible for expectant management. This highlights a need for better implementation of tailored expectant management guidelines.

Keywords:
expectant managementguideline adherenceimplementationprognostic modelsunexplained infertility

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Area of Science:

  • Reproductive Medicine
  • Infertility Management
  • Clinical Guidelines

Background:

  • Prognostic models aid in identifying infertile couples who would benefit from fertility treatment.
  • Tailored expectant management (TEM) of 6-12 months is recommended for unexplained infertility with a good chance of natural conception, preventing unnecessary interventions.
  • The Hunault prediction model helps assess natural conception probability within one year.

Purpose of the Study:

  • To determine the percentage of overtreatment in couples with unexplained infertility eligible for TEM.
  • To identify factors associated with overtreatment in this population.

Main Methods:

  • Retrospective cohort study involving 544 couples with unexplained infertility eligible for TEM.
  • Data collected from medical records (2011-2012) across 25 clinics.
  • Multilevel regression analyses used to investigate associations with patient and clinic characteristics.

Main Results:

  • Overtreatment (starting medically assisted reproduction within 6 months) occurred in 36% of eligible couples.
  • Prognosis was not calculated in 34% of cases, and expectant management was not recommended in 42%.
  • Overtreatment was associated with childlessness, higher female age, and longer infertility duration.

Conclusions:

  • Developing and publishing TEM guidelines is insufficient; overtreatment remains frequent.
  • Future research should focus on implementing TEM guideline recommendations effectively.
  • Targeted efforts are needed to ensure appropriate expectant management for infertile couples.