Skip to main content
PMC home page
The British Journal of General Practice logoLink to The British Journal of General Practice
. 1997 Feb;47(415):111–118.

Management of involuntary childlessness.

W Himmel 1, E Ittner 1, M M Kochen 1, H W Michelmann 1, B Hinney 1, M Reuter 1, M Kallerhoff 1, R H Ringert 1
PMCID: PMC1312893  PMID: 9101672

Abstract

Any definition of involuntary childlessness has to consider the difference between sterility and subfertility. As the latter affects about 20-30% of all couples at least once in their lives, general practitioners (GPs) may be the first to be confronted with this problem. This review presents the most relevant diagnostic and therapeutic options in cases of female or male infertility, and discusses the new assisted reproductive technologies (such as insemination, in vitro fertilization, gamete transfer and intracytoplasmatic sperm injection) so that GPs may adequately inform their patients about these procedures and their risks and outcomes. Although controversial, involuntary childlessness and its clinical treatment seem to have a strong psychological impact on a couple's social, emotional and sexual life. Being available for discussion with childless couples and offering ongoing support may be the most important role for the GP in this context.

Full Text

The Full Text of this article is available as a PDF (81.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aafjes J. H., van der Vijver J. C. Fertility of men with and without a varicocele. Fertil Steril. 1985 Jun;43(6):901–904. doi: 10.1016/s0015-0282(16)48619-x. [DOI] [PubMed] [Google Scholar]
  2. Aitken R. J., West K., Buckingham D. Leukocytic infiltration into the human ejaculate and its association with semen quality, oxidative stress, and sperm function. J Androl. 1994 Jul-Aug;15(4):343–352. [PubMed] [Google Scholar]
  3. Appleton T. Ethical issues in assisted reproductive medicine: a pragmatic approach. Br J Urol. 1995 Nov;76 (Suppl 2):85–92. doi: 10.1111/j.1464-410x.1995.tb07878.x. [DOI] [PubMed] [Google Scholar]
  4. Aral S. O., Cates W., Jr The increasing concern with infertility. Why now? JAMA. 1983 Nov 4;250(17):2327–2331. [PubMed] [Google Scholar]
  5. Auger J., Kunstmann J. M., Czyglik F., Jouannet P. Decline in semen quality among fertile men in Paris during the past 20 years. N Engl J Med. 1995 Feb 2;332(5):281–285. doi: 10.1056/NEJM199502023320501. [DOI] [PubMed] [Google Scholar]
  6. BENEDEK T. Infertility as a psychosomatic defense. Fertil Steril. 1952 Nov-Dec;3(6):527–541. doi: 10.1016/s0015-0282(16)31084-6. [DOI] [PubMed] [Google Scholar]
  7. Becker G., Nachtigall R. D. Ambiguous responsibility in the doctor-patient relationship: the case of infertility. Soc Sci Med. 1991;32(8):875–885. doi: 10.1016/0277-9536(91)90243-6. [DOI] [PubMed] [Google Scholar]
  8. Bell J. S. Psychological problems among patients attending an infertility clinic. J Psychosom Res. 1981;25(1):1–3. doi: 10.1016/0022-3999(81)90077-5. [DOI] [PubMed] [Google Scholar]
  9. Berg B. J., Wilson J. F. Psychological functioning across stages of treatment for infertility. J Behav Med. 1991 Feb;14(1):11–26. doi: 10.1007/BF00844765. [DOI] [PubMed] [Google Scholar]
  10. Berger R. E., Karp L. E., Williamson R. A., Koehler J., Moore D. E., Holmes K. K. The relationship of pyospermia and seminal fluid bacteriology to sperm function as reflected in the sperm penetration assay. Fertil Steril. 1982 Apr;37(4):557–564. doi: 10.1016/s0015-0282(16)46166-2. [DOI] [PubMed] [Google Scholar]
  11. Bopp B. L., Alper M. M., Thompson I. E., Mortola J. Success rates with gamete intrafallopian transfer and in vitro fertilization in women of advanced maternal age. Fertil Steril. 1995 Jun;63(6):1278–1283. doi: 10.1016/s0015-0282(16)57611-0. [DOI] [PubMed] [Google Scholar]
  12. Brand H. J. Psychological stress and infertility. Part 2: Psychometric test data. Br J Med Psychol. 1982 Dec;55(Pt 4):385–388. doi: 10.1111/j.2044-8341.1982.tb01524.x. [DOI] [PubMed] [Google Scholar]
  13. Brinsden P. R., Wada I., Tan S. L., Balen A., Jacobs H. S. Diagnosis, prevention and management of ovarian hyperstimulation syndrome. Br J Obstet Gynaecol. 1995 Oct;102(10):767–772. doi: 10.1111/j.1471-0528.1995.tb10840.x. [DOI] [PubMed] [Google Scholar]
  14. Bullock J. L. Iatrogenic impotence in an infertility clinic: illustrative case. Am J Obstet Gynecol. 1974 Oct 15;120(4):476–478. doi: 10.1016/0002-9378(74)90624-3. [DOI] [PubMed] [Google Scholar]
  15. Camilleri A. P. A realistic approach to infertility. Practitioner. 1980 Aug;224(1346):835–837. [PubMed] [Google Scholar]
  16. Carlsen E., Giwercman A., Keiding N., Skakkebaek N. E. Evidence for decreasing quality of semen during past 50 years. BMJ. 1992 Sep 12;305(6854):609–613. doi: 10.1136/bmj.305.6854.609. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Chakraborty J., Hikim A. P., Jhunjhunwala J. S. Stagnation of blood in the microcirculatory vessels in the testes of men with varicocele. J Androl. 1985 Mar-Apr;6(2):117–126. doi: 10.1002/j.1939-4640.1985.tb00826.x. [DOI] [PubMed] [Google Scholar]
  18. Cohen I., Speroff L. Premature ovarian failure: update. Obstet Gynecol Surv. 1991 Mar;46(3):156–162. doi: 10.1097/00006254-199103000-00015. [DOI] [PubMed] [Google Scholar]
  19. Collins J. A. A couple with infertility. JAMA. 1995 Oct 11;274(14):1159–1164. [PubMed] [Google Scholar]
  20. Collins J. A., Wrixon W., Janes L. B., Wilson E. H. Treatment-independent pregnancy among infertile couples. N Engl J Med. 1983 Nov 17;309(20):1201–1206. doi: 10.1056/NEJM198311173092001. [DOI] [PubMed] [Google Scholar]
  21. Corfman R. S., Ball G. D. Treatment options for infertile couples. Minn Med. 1994 Mar;77(3):28–32. [PubMed] [Google Scholar]
  22. Crosignani P. G., Walters D. E. Clinical pregnancy and male subfertility; the ESHRE multicentre trial on the treatment of male subfertility. European Society of Human Reproduction and Embryology. Hum Reprod. 1994 Jun;9(6):1112–1118. doi: 10.1093/oxfordjournals.humrep.a138642. [DOI] [PubMed] [Google Scholar]
  23. Dawood M. Y. In vitro fertilization, gamete intrafallopian transfer, and superovulation with intrauterine insemination: efficacy and potential health hazards on babies delivered. Am J Obstet Gynecol. 1996 Apr;174(4):1208–1217. doi: 10.1016/s0002-9378(96)70663-4. [DOI] [PubMed] [Google Scholar]
  24. Debrovner C. H., Shubin-Stein R. Sexual problems associated with infertility. Med Aspects Hum Sex. 1976 Mar;10(3):161–162. [PubMed] [Google Scholar]
  25. Deichert U., Schlief R., van de Sandt M., Daume E. Transvaginal hysterosalpingo-contrast sonography for the assessment of tubal patency with gray scale imaging and additional use of pulsed wave Doppler. Fertil Steril. 1992 Jan;57(1):62–67. doi: 10.1016/s0015-0282(16)54777-3. [DOI] [PubMed] [Google Scholar]
  26. Denber H. C., Roland M. Effect of tybamate on psychosomatic symptoms in a group of infertility patients. A double-blind study. Fertil Steril. 1969 May-Jun;20(3):373–379. doi: 10.1016/s0015-0282(16)37021-2. [DOI] [PubMed] [Google Scholar]
  27. Dubin L., Amelar R. D. Magnified surgery for epididymovasostomy. Urology. 1984 May;23(5):525–528. doi: 10.1016/s0090-4295(84)80015-1. [DOI] [PubMed] [Google Scholar]
  28. EISNER B. G. SOME PSYCHOLOGICAL DIFFERENCES BETWEEN FERTILE AND INFERTILE WOMEN. J Clin Psychol. 1963 Oct;19:391–395. doi: 10.1002/1097-4679(196310)19:4<391::aid-jclp2270190403>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
  29. Edelmann R. J., Connolly K. J. Psychological aspects of infertility. Br J Med Psychol. 1986 Sep;59(Pt 3):209–219. doi: 10.1111/j.2044-8341.1986.tb02686.x. [DOI] [PubMed] [Google Scholar]
  30. Emslie C., Grimshaw J., Templeton A. Do clinical guidelines improve general practice management and referral of infertile couples? BMJ. 1993 Jun 26;306(6894):1728–1731. doi: 10.1136/bmj.306.6894.1728. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Engelmann U. H., Schramek P., Tomamichel G., Deindl F., Senge T. Vasectomy reversal in central Europe: results of questionnaire of urologists in Austria, Germany and Switzerland. J Urol. 1990 Jan;143(1):64–67. doi: 10.1016/s0022-5347(17)39867-1. [DOI] [PubMed] [Google Scholar]
  32. FORD E. S., FORMAN I., WILLSON J. R., CHAR W., MIXSON W. T., SCHOLZ C. A psychodynamic approach to the study of infertility. Fertil Steril. 1953 Nov-Dec;4(6):456–465. doi: 10.1016/s0015-0282(16)31441-8. [DOI] [PubMed] [Google Scholar]
  33. Filicori M., Flamigni C., Dellai P., Cognigni G., Michelacci L., Arnone R., Sambataro M., Falbo A. Treatment of anovulation with pulsatile gonadotropin-releasing hormone: prognostic factors and clinical results in 600 cycles. J Clin Endocrinol Metab. 1994 Oct;79(4):1215–1220. doi: 10.1210/jcem.79.4.7962297. [DOI] [PubMed] [Google Scholar]
  34. Fisch H., Goluboff E. T., Olson J. H., Feldshuh J., Broder S. J., Barad D. H. Semen analyses in 1,283 men from the United States over a 25-year period: no decline in quality. Fertil Steril. 1996 May;65(5):1009–1014. doi: 10.1016/s0015-0282(16)58278-8. [DOI] [PubMed] [Google Scholar]
  35. Fogdestam I., Fall M., Nilsson S. Microsurgical epididymovasostomy in the treatment of occlusive azoospermia. Fertil Steril. 1986 Nov;46(5):925–929. doi: 10.1016/s0015-0282(16)49836-5. [DOI] [PubMed] [Google Scholar]
  36. Freeman E. W., Garcia C. R., Rickels K. Behavioral and emotional factors: comparisons of anovulatory infertile women with fertile and other infertile women. Fertil Steril. 1983 Aug;40(2):195–201. doi: 10.1016/s0015-0282(16)47237-7. [DOI] [PubMed] [Google Scholar]
  37. Frey K., Dodson W., Andolsek K., Klein J. Infertility: a family practice approach. J Fam Pract. 1988 May;26(5):499, 502-5. [PubMed] [Google Scholar]
  38. Gomel V. From microsurgery to laparoscopic surgery: a progress. Fertil Steril. 1995 Mar;63(3):464–468. doi: 10.1016/s0015-0282(16)57409-3. [DOI] [PubMed] [Google Scholar]
  39. Graebe R. A. The role of endoscopy in the management of the infertile patient. Curr Opin Obstet Gynecol. 1995 Aug;7(4):265–272. [PubMed] [Google Scholar]
  40. Greenberg S. H., Lipshultz L. I., Wein A. J. Experience with 425 subfertile male patients. J Urol. 1978 Apr;119(4):507–510. doi: 10.1016/s0022-5347(17)57531-x. [DOI] [PubMed] [Google Scholar]
  41. Grimshaw J., Emslie C. Managing infertility--the GP's role. Practitioner. 1994 Aug;238(1541):586–590. [PubMed] [Google Scholar]
  42. Gunnell D. J., Ewings P. Infertility prevalence, needs assessment and purchasing. J Public Health Med. 1994 Mar;16(1):29–35. doi: 10.1093/oxfordjournals.pubmed.a042931. [DOI] [PubMed] [Google Scholar]
  43. Harrison R. F., O'Moore R. R., O'Moore A. M. Stress and fertility: some modalities of investigation and treatment in couples with unexplained infertility in Dublin. Int J Fertil. 1986 May-Jun;31(2):153–159. [PubMed] [Google Scholar]
  44. Healy D. L., Trounson A. O., Andersen A. N. Female infertility: causes and treatment. Lancet. 1994 Jun 18;343(8912):1539–1544. doi: 10.1016/s0140-6736(94)92941-6. [DOI] [PubMed] [Google Scholar]
  45. Hinney B., Henze C., Kuhn W., Wuttke W. The corpus luteum insufficiency: a multifactorial disease. J Clin Endocrinol Metab. 1996 Feb;81(2):565–570. doi: 10.1210/jcem.81.2.8636268. [DOI] [PubMed] [Google Scholar]
  46. Holmes H. B. In vitro fertilization: reflections on the state of the art. Birth. 1988 Sep;15(3):134–145. doi: 10.1111/j.1523-536x.1988.tb01093.x. [DOI] [PubMed] [Google Scholar]
  47. Hope T., Lockwood G., Lockwood M., Bewley S., Jackson J., Craft I. Should older women be offered in vitro fertilisation? BMJ. 1995 Jun 3;310(6992):1455–1458. doi: 10.1136/bmj.310.6992.1455. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Howards S. S. Treatment of male infertility. N Engl J Med. 1995 Feb 2;332(5):312–317. doi: 10.1056/NEJM199502023320507. [DOI] [PubMed] [Google Scholar]
  49. Hull M. G. Effectiveness of infertility treatments: choice and comparative analysis. Int J Gynaecol Obstet. 1994 Nov;47(2):99–108. doi: 10.1016/0020-7292(94)90348-4. [DOI] [PubMed] [Google Scholar]
  50. Hull M. G., Glazener C. M., Kelly N. J., Conway D. I., Foster P. A., Hinton R. A., Coulson C., Lambert P. A., Watt E. M., Desai K. M. Population study of causes, treatment, and outcome of infertility. Br Med J (Clin Res Ed) 1985 Dec 14;291(6510):1693–1697. doi: 10.1136/bmj.291.6510.1693. [DOI] [PMC free article] [PubMed] [Google Scholar]
  51. Jeker L., Micioni G., Ruspa M., Zeeb M., Campana A. Wish for a child and infertility: study on 116 couples. I. Interview and psychodynamic hypotheses. Int J Fertil. 1988 Nov-Dec;33(6):411–420. [PubMed] [Google Scholar]
  52. Johnson G. Childless women revisited. South Bedfordshire Practitioners' Group. BMJ. 1993 Oct 30;307(6912):1116–1117. doi: 10.1136/bmj.307.6912.1116. [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Jones H. W., Jr, Toner J. P. The infertile couple. N Engl J Med. 1993 Dec 2;329(23):1710–1715. doi: 10.1056/NEJM199312023292307. [DOI] [PubMed] [Google Scholar]
  54. Kaufman S. A. Impact of infertility on the marital and sexual relationship. Fertil Steril. 1969 May-Jun;20(3):380–383. doi: 10.1016/s0015-0282(16)37022-4. [DOI] [PubMed] [Google Scholar]
  55. Kemeter P., Eder A., Springer-Kremser M. Psychosocial testing and pretreatment of women for in vitro fertilization. Ann N Y Acad Sci. 1985;442:523–532. doi: 10.1111/j.1749-6632.1985.tb37560.x. [DOI] [PubMed] [Google Scholar]
  56. Kemeter P. Studies on psychosomatic implications of infertility--effects of emotional stress on fertilization and implantation in in-vitro fertilization. Hum Reprod. 1988 Apr;3(3):341–352. doi: 10.1093/oxfordjournals.humrep.a136706. [DOI] [PubMed] [Google Scholar]
  57. Kenny D. T. The impact of maternal age on clinical pregnancy and spontaneous abortion in women undergoing in vitro fertilization and gamete intra-fallopian transfer. Aust N Z J Obstet Gynaecol. 1994 Aug;34(4):443–448. doi: 10.1111/j.1479-828x.1994.tb01267.x. [DOI] [PubMed] [Google Scholar]
  58. Klosterhalfen H., Wagenknecht L. V., Becker H., Huland H., Schirren C. Operationsresultate der Epididymo-Vasostomie und der Vaso-Vasostomie. Urologe A. 1983 Jan;22(1):25–28. [PubMed] [Google Scholar]
  59. Kraft A. D., Palombo J., Mitchell D., Dean C., Meyers S., Schmidt A. W. The psychological dimensions of infertility. Am J Orthopsychiatry. 1980 Oct;50(4):618–628. doi: 10.1111/j.1939-0025.1980.tb03324.x. [DOI] [PubMed] [Google Scholar]
  60. Lalos A., Lalos O., Jacobsson L., von Schoultz B. Psychological reactions to the medical investigation and surgical treatment of infertility. Gynecol Obstet Invest. 1985;20(4):209–217. doi: 10.1159/000298996. [DOI] [PubMed] [Google Scholar]
  61. Leiblum S. R., Kemmann E., Colburn D., Pasquale S., DeLisi A. M. Unsuccessful in vitro fertilization: a follow-up study. J In Vitro Fert Embryo Transf. 1987 Feb;4(1):46–50. doi: 10.1007/BF01555435. [DOI] [PubMed] [Google Scholar]
  62. Lu P. Y., Ory S. J. Endometriosis: current management. Mayo Clin Proc. 1995 May;70(5):453–463. doi: 10.4065/70.5.453. [DOI] [PubMed] [Google Scholar]
  63. Mahlstedt P. P., Macduff S., Bernstein J. Emotional factors and the in vitro fertilization and embryo transfer process. J In Vitro Fert Embryo Transf. 1987 Aug;4(4):232–236. doi: 10.1007/BF01533762. [DOI] [PubMed] [Google Scholar]
  64. Mahlstedt P. P. The psychological component of infertility. Fertil Steril. 1985 Mar;43(3):335–346. doi: 10.1016/s0015-0282(16)48428-1. [DOI] [PubMed] [Google Scholar]
  65. Mai F. M., Munday R. N., Rump E. E. Psychiatric interview comparisons between infertile and fertile couples. Psychosom Med. 1972 Sep-Oct;34(5):431–440. doi: 10.1097/00006842-197209000-00006. [DOI] [PubMed] [Google Scholar]
  66. Martinez A. R., Bernadus R. E., Voorhorst F. J., Vermeiden J. P., Schoemaker J. A controlled study of human chorionic gonadotrophin induced ovulation versus urinary luteinizing hormone surge for timing of intrauterine insemination. Hum Reprod. 1991 Oct;6(9):1247–1251. doi: 10.1093/oxfordjournals.humrep.a137521. [DOI] [PubMed] [Google Scholar]
  67. Menning B. E. The emotional needs of infertile couples. Fertil Steril. 1980 Oct;34(4):313–319. doi: 10.1016/s0015-0282(16)45031-4. [DOI] [PubMed] [Google Scholar]
  68. Michelmann H. W., Hinney B. Ethical reflections on the status of the preimplantation embryo leading to the German Embryo Protection Act. Sci Eng Ethics. 1995 Apr;1(2):145–150. doi: 10.1007/BF02584070. [DOI] [PubMed] [Google Scholar]
  69. Michelmann H. W. Minimal criteria of sperm quality for insemination and IVF therapy. Int J Androl. 1995 Dec;18 (Suppl 2):81–87. [PubMed] [Google Scholar]
  70. Moltz L., Leidenberger F., Weise C. Rationelle hormonale Diagnostik der normozyklischen funktionellen Sterilität. Geburtshilfe Frauenheilkd. 1991 Sep;51(9):756–768. doi: 10.1055/s-2007-1023829. [DOI] [PubMed] [Google Scholar]
  71. Mosher W. D., Pratt W. F. Fecundity and infertility in the United States: incidence and trends. Fertil Steril. 1991 Aug;56(2):192–193. [PubMed] [Google Scholar]
  72. Mozley P. D. Psychophysiologic infertility: an overview. Clin Obstet Gynecol. 1976 Jun;19(2):407–417. doi: 10.1097/00003081-197606000-00014. [DOI] [PubMed] [Google Scholar]
  73. Nau Jean-Yves. Bioethics laws in France. Lancet. 1994 Jul 2;344(8914):48–48. doi: 10.1016/s0140-6736(94)91060-x. [DOI] [PubMed] [Google Scholar]
  74. Nijs P., Koninckx P. R., Verstraeten D., Mullens A., Nicasy H. Psychological factors of female infertility. Eur J Obstet Gynecol Reprod Biol. 1984 Dec;18(5-6):375–379. doi: 10.1016/0028-2243(84)90060-1. [DOI] [PubMed] [Google Scholar]
  75. O'Moore A. M., O'Moore R. R., Harrison R. F., Murphy G., Carruthers M. E. Psychosomatic aspects in idiopathic infertility: effects of treatment with autogenic training. J Psychosom Res. 1983;27(2):145–151. doi: 10.1016/0022-3999(83)90091-0. [DOI] [PubMed] [Google Scholar]
  76. Olsen G. W., Bodner K. M., Ramlow J. M., Ross C. E., Lipshultz L. I. Have sperm counts been reduced 50 percent in 50 years? A statistical model revisited. Fertil Steril. 1995 Apr;63(4):887–893. doi: 10.1016/s0015-0282(16)57498-6. [DOI] [PubMed] [Google Scholar]
  77. Oxman A. D. Checklists for review articles. BMJ. 1994 Sep 10;309(6955):648–651. doi: 10.1136/bmj.309.6955.648. [DOI] [PMC free article] [PubMed] [Google Scholar]
  78. Pache T. D., de Jong F. H., Hop W. C., Fauser B. C. Association between ovarian changes assessed by transvaginal sonography and clinical and endocrine signs of the polycystic ovary syndrome. Fertil Steril. 1993 Mar;59(3):544–549. doi: 10.1016/s0015-0282(16)55797-5. [DOI] [PubMed] [Google Scholar]
  79. Page H. Estimation of the prevalence and incidence of infertility in a population: a pilot study. Fertil Steril. 1989 Apr;51(4):571–577. doi: 10.1016/s0015-0282(16)60601-5. [DOI] [PubMed] [Google Scholar]
  80. Palermo G. D., Cohen J., Rosenwaks Z. Intracytoplasmic sperm injection: a powerful tool to overcome fertilization failure. Fertil Steril. 1996 May;65(5):899–908. doi: 10.1016/s0015-0282(16)58257-0. [DOI] [PubMed] [Google Scholar]
  81. Paulsen C. A., Berman N. G., Wang C. Data from men in greater Seattle area reveals no downward trend in semen quality: further evidence that deterioration of semen quality is not geographically uniform. Fertil Steril. 1996 May;65(5):1015–1020. [PubMed] [Google Scholar]
  82. Paulson J. D., Haarmann B. S., Salerno R. L., Asmar P. An investigation of the relationship between emotional maladjustment and infertility. Fertil Steril. 1988 Feb;49(2):258–262. doi: 10.1016/s0015-0282(16)59712-x. [DOI] [PubMed] [Google Scholar]
  83. Paulson R. J., Sauer M. V. Counseling the infertile couple: when enough is enough. Obstet Gynecol. 1991 Sep;78(3 Pt 1):462–464. [PubMed] [Google Scholar]
  84. Pepperell R. J. Folliculogenesis--the stimulated way. Aust N Z J Obstet Gynaecol. 1994 Jun;34(3):272–276. doi: 10.1111/j.1479-828x.1994.tb01072.x. [DOI] [PubMed] [Google Scholar]
  85. Pepperell R. J., McBain J. C. Unexplained infertility: a review. Br J Obstet Gynaecol. 1985 Jun;92(6):569–580. doi: 10.1111/j.1471-0528.1985.tb01394.x. [DOI] [PubMed] [Google Scholar]
  86. Platt J. J., Ficher I., Silver M. J. Infertile couples: personality traits and self-ideal concept discrepancies. Fertil Steril. 1973 Dec;24(12):972–976. doi: 10.1016/s0015-0282(16)40097-x. [DOI] [PubMed] [Google Scholar]
  87. Rachootin P., Olsen J. Social selection in seeking medical care for reduced fecundity among women in Denmark. J Epidemiol Community Health. 1981 Dec;35(4):262–264. doi: 10.1136/jech.35.4.262. [DOI] [PMC free article] [PubMed] [Google Scholar]
  88. Renne K. S. Childlessness, health, and marital satisfaction. Soc Biol. 1976 Fall;23(3):183–197. doi: 10.1080/19485565.1976.9988230. [DOI] [PubMed] [Google Scholar]
  89. Sauer M. V., Paulson R. J., Ary B. A., Lobo R. A. Three hundred cycles of oocyte donation at the University of Southern California: assessing the effect of age and infertility diagnosis on pregnancy and implantation rates. J Assist Reprod Genet. 1994 Feb;11(2):92–96. doi: 10.1007/BF02215994. [DOI] [PubMed] [Google Scholar]
  90. Schenker J. G., Ezra Y. Complications of assisted reproductive techniques. Fertil Steril. 1994 Mar;61(3):411–422. doi: 10.1016/s0015-0282(16)56568-6. [DOI] [PubMed] [Google Scholar]
  91. Seibel M. M., Taymor M. L. Emotional aspects of infertility. Fertil Steril. 1982 Feb;37(2):137–145. doi: 10.1016/s0015-0282(16)46029-2. [DOI] [PubMed] [Google Scholar]
  92. Sharlip I. D. What is the best pregnancy rate that may be expected from vasectomy reversal? J Urol. 1993 Jun;149(6):1469–1471. doi: 10.1016/s0022-5347(17)36417-0. [DOI] [PubMed] [Google Scholar]
  93. Sherins R. J., Thorsell L. P., Dorfmann A., Dennison-Lagos L., Calvo L. P., Krysa L., Coulam C. B., Schulman J. D. Intracytoplasmic sperm injection facilitates fertilization even in the most severe forms of male infertility: pregnancy outcome correlates with maternal age and number of eggs available. Fertil Steril. 1995 Aug;64(2):369–375. doi: 10.1016/s0015-0282(16)57737-1. [DOI] [PubMed] [Google Scholar]
  94. Silber S. J. Microscopic vasoepididymostomy: specific microanastomosis to the epididymal tubule. Fertil Steril. 1978 Nov;30(5):565–571. [PubMed] [Google Scholar]
  95. Singh J. R., Neki J. S. Psychogenic factors in some genetic and non-genetic forms of infertility. Int J Gynaecol Obstet. 1982 Apr;20(2):119–123. doi: 10.1016/0020-7292(82)90022-4. [DOI] [PubMed] [Google Scholar]
  96. Skakkebaek N. E., Giwercman A., de Kretser D. Pathogenesis and management of male infertility. Lancet. 1994 Jun 11;343(8911):1473–1479. doi: 10.1016/s0140-6736(94)92586-0. [DOI] [PubMed] [Google Scholar]
  97. Slade P. Menstrual cycle symptoms in infertile and control subjects: a re-evaluation of the evidence for psychological changes. J Psychosom Res. 1981;25(3):175–181. doi: 10.1016/0022-3999(81)90030-1. [DOI] [PubMed] [Google Scholar]
  98. Slade P. Sexual attitudes and social role orientations in infertile women. J Psychosom Res. 1981;25(3):183–186. doi: 10.1016/0022-3999(81)90031-3. [DOI] [PubMed] [Google Scholar]
  99. Smith S., Hosid S., Scott L. Use of postseparation sperm parameters to determine the method of choice for sperm preparation for assisted reproductive technology. Fertil Steril. 1995 Mar;63(3):591–597. doi: 10.1016/s0015-0282(16)57431-7. [DOI] [PubMed] [Google Scholar]
  100. Templeton A., Fraser C., Thompson B. Infertility--epidemiology and referral practice. Hum Reprod. 1991 Nov;6(10):1391–1394. doi: 10.1093/oxfordjournals.humrep.a137275. [DOI] [PubMed] [Google Scholar]
  101. Templeton A., Fraser C., Thompson B. The epidemiology of infertility in Aberdeen. BMJ. 1990 Jul 21;301(6744):148–152. doi: 10.1136/bmj.301.6744.148. [DOI] [PMC free article] [PubMed] [Google Scholar]
  102. Trounson A., Dawson K. Storage and disposal of embryos and gametes. BMJ. 1996 Jul 6;313(7048):1–2. doi: 10.1136/bmj.313.7048.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  103. Tzafettas J., Loufopoulos A., Stephanatos A., Mukherjee A. Tubal catheterization for intrafallopian insemination and transvaginal gamete (GIFT) or zygote intrafallopian transfer (ZIFT): our experience in a total of 1128 treatment cycles. J Assist Reprod Genet. 1994 Jul;11(6):283–288. doi: 10.1007/BF02215714. [DOI] [PubMed] [Google Scholar]
  104. Valentine D. P. Psychological impact of infertility: identifying issues and needs. Soc Work Health Care. 1986 Summer;11(4):61–69. doi: 10.1300/J010v11n04_05. [DOI] [PubMed] [Google Scholar]
  105. Wallace L. M. Psychological adjustment to and recovery from laparoscopic sterilization and infertility investigation. J Psychosom Res. 1985;29(5):507–518. doi: 10.1016/0022-3999(85)90084-4. [DOI] [PubMed] [Google Scholar]
  106. Waterstone J. Investigation of subfertility. Practitioner. 1992 Feb;236(1511):141–144. [PubMed] [Google Scholar]
  107. Webster J., Piscitelli G., Polli A., Ferrari C. I., Ismail I., Scanlon M. F. A comparison of cabergoline and bromocriptine in the treatment of hyperprolactinemic amenorrhea. Cabergoline Comparative Study Group. N Engl J Med. 1994 Oct 6;331(14):904–909. doi: 10.1056/NEJM199410063311403. [DOI] [PubMed] [Google Scholar]
  108. Weise H. C., Moltz L., Bispink G., Leidenberger F. Rationelle hormonale Diagnostik der Oligomenorrhö. Geburtshilfe Frauenheilkd. 1989 Aug;49(8):694–700. doi: 10.1055/s-2008-1036068. [DOI] [PubMed] [Google Scholar]
  109. Whiteford L. M., Gonzalez L. Stigma: the hidden burden of infertility. Soc Sci Med. 1995 Jan;40(1):27–36. doi: 10.1016/0277-9536(94)00124-c. [DOI] [PubMed] [Google Scholar]
  110. Wilkes S., Jones K. Retrospective review of the prevalence and management of infertility in women in one practice over a five year period. Br J Gen Pract. 1995 Feb;45(391):75–77. [PMC free article] [PubMed] [Google Scholar]
  111. de Zoeten M. J., Tymstra T., Alberda A. T. The waiting-list for IVF. The motivations and expectations of women waiting for IVF treatment. Hum Reprod. 1987 Oct;2(7):623–626. doi: 10.1093/oxfordjournals.humrep.a136602. [DOI] [PubMed] [Google Scholar]
  112. ten Have H. Letters to Dr Frankenstein? Ethics and the new reproductive technologies. Soc Sci Med. 1995 Jan;40(2):141–146. doi: 10.1016/0277-9536(94)00178-v. [DOI] [PubMed] [Google Scholar]
  113. van Hall Eylard V. Manipulation of human reproduction. J Psychosom Obstet Gynaecol. 1988 Dec;9(3):207–213. doi: 10.3109/01674828809016803. [DOI] [PubMed] [Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

RESOURCES