Infertility is the failure to conceive after 12 months of regular unprotected sexual intercourse. In couples who have never conceived, this is called -primary infertility, while in couples that have previously conceived, it is referred to as secondary infertility. This affects up to one in seven couples in the UK.1
Infertility occurs more commonly with increasing age and can be associated with ovulatory disorders such as polycystic ovary syndrome in 25% of couples or tubal damage in a further 20% of couples.2 Male factor infertility can be related to low sperm count or low sperm quality and might affect up to 30% of couples.2
Given that over 80% of couples will conceive if there is regular intercourse over a one year period if the woman is under the age of 40, investigation should usually be instigated after this.2 In women older than 35, an earlier specialist referral may be considered as female fertility declines with age.2 Early specialist referral can also be considered if the clinical assessment suggests an underlying cause like uterine factors and gynaecological conditions such as endometriosis. Referral criteria may vary in different geographical areas.