Infertility: Evaluation and Initial Management

The 2012 document outlines the role of advanced practice clinicians in the initial evaluation and management of infertility, which affects 1.5 million married women in the U.S. It defines infertility based on the duration of unprotected intercourse without conception and provides a treatment algorithm. The evaluation includes semen analysis, assessment of ovulatory function, ovarian reserve, and tubal patency. Lifestyle modifications and the use of oral ovulation-inducing agents like clomiphene citrate and letrozole are recommended before referral to a specialist. Clomiphene citrate is the standard treatment for ovulation induction but may have side effects and increase the risk of multiple pregnancies. Letrozole, used off-label, has fewer side effects and a lower risk of multiples. The document also discusses the emotional impact of infertility and the importance of addressing psychosocial wellness in fertility care.