ACR Appropriateness Criteria® Female Infertility

Infertility is defined as the inability to conceive spontaneously after 12 months of routinely unprotected intercourse in patients <35 years of age, and after 6 months in patients ≥35 years of age. Infertility also refers to the inability to achieve a successful pregnancy based on the medical, sexual, and reproductive history; age, physical findings; diagnostic testing; the need for medical intervention; or a combination of these variables for a patient. In the United States, 13% of women 15 to 49 years of age have accessed assisted fertility services and it has been suggested that the rate of infertility has been increasing, without geographic bias. Understanding the initial imaging evaluation is essential to this often complex and/or multifaceted clinical circumstance, which may involve the ovaries, uterus, and fallopian tubes. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.