Revised Definition of Infertility
The American Society of Reproductive Medicine (ASRM) has revised the definition of infertility to encourage earlier evaluation and treatment in the highest risk group. Infertility has traditionally been defined as the inability to conceive after twelve months of regular, unprotected intercourse. According to the new guidelines, published by the ASRM in the June 2008 issue of its society journal Fertility and Sterility, women over 35 years of age are now encouraged to seek fertility evaluation if they fail to conceive after only six months of trying.
Rationale for Change
The rationale behind the new ASRM report addresses important and practical issues in fertility care. Fecundability (the probability of conceiving in one menstrual cycle) in women is known to decrease with age, but drops most dramatically after the age of 35 (see figure). Earlier testing and treatment in these patients can result in significantly higher pregnancy rates. In addition, the risk of chromosomal abnormalities, or aneuploidy, including Down syndrome also increases with maternal age. Aneuploidy risk increases progressively as women age, and women 35 years and older are comprise the highest risk group. Despite these statistics, insurers have often denied timely fertility evaluation and treatment by adhering strictly to the one-year definition of infertility.
ASRM members have long requested the new definition. By revising the definition in women over 35, the ASRM hopes to improve fertility awareness and access to care for women who need it the most.