Introduction to epidemiology, ethical and legal issues of subfertility

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Image credit: Bill McConkey (Wellcome Photo Library).

Subfertility can be defined as a delay in conception after regular unprotected sexual intercourse and affects approximately one in six to seven couples in the Western world. Most couples have relative subfertillity, i.e., a reduced chance of spontaneous conception in each menstrual cycle compared with other couples, while a small minority of couples have absolute infertility and no chance of natural conception.

Increasing female age has a profound negative effect on the likelihood of pregnancy, both natural conception and with any fertility treatment options. This is particularly true for women over 40 years of age. As women delay becoming mothers, the incidence of subfertility is likely to rise. The desire to have a child is a very basic human need for most individuals, and subfertility can cause enormous distress to those individuals affected.

Every MRCOG candidate must have an understanding of the management of a couple presenting with subfertility. This tutorial provides an overview of the major causes of subfertility together with some of the relevant ethical and legal issues.

Please note that this tutorial may go beyond the knowledge required of MRCOG Part 2 candidates, and would also be useful for post-MRCOG trainees and consultants.

Learning objectives

When you have completed this tutorial you will understand: