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Review
. 2021 Jan 19:11:591837.
doi: 10.3389/fendo.2020.591837. eCollection 2020.

Practical Clinical and Diagnostic Pathway for the Investigation of the Infertile Couple

Andrea Garolla  1 , Damiano Pizzol  1   2 , Andrea Roberto Carosso  3 , Andrea Borini  4 , Filippo Maria Ubaldi  5 , Aldo Eugenio Calogero  6 , Alberto Ferlin  7 , Antonio Lanzone  8   9 , Francesco Tomei  10 , Bruno Engl  11 , Laura Rienzi  5 , Lucia De Santis  12   13 , Giovanni Coticchio  4 , Lee Smith  14 , Rossella Cannarella  6 , Attilio Anastasi  15 , Massimo Menegazzo  1 , Liborio Stuppia  16   17 , Christian Corsini  1 , Carlo Foresta  1
Affiliations
Review

Practical Clinical and Diagnostic Pathway for the Investigation of the Infertile Couple

Andrea Garolla et al. Front Endocrinol (Lausanne). .

Abstract

Capsule: This expert opinion summarizes current knowledge on risk factors for infertility and identifies a practical clinical and diagnostic approach for the male and female partners of an infertile couple aimed to improve the investigation and management of fertility problems.

Background: Infertility represents an important and growing health problem affecting up to 16% of couples worldwide. In most cases, male, female, or combined factor can be identified, and different causes or risk factors have been related to this condition. However, there are no standardized guidelines on the clinical-diagnostic approach of infertile couples and the recommendations concerning infertility are sometimes lacking, incomplete, or problematic to apply.

Objective: The aim of this work is to provide an appropriate clinical and diagnostic pathway for infertile couples designed by a multidisciplinary-team of experts. The rationale is based on the history and physical examination and then oriented on the basis of initial investigations. This approach could be applied in order to reduce variation in practice and to improve the investigation and management of fertility problems.

Methods: Prominent Italian experts of the main specialties committed in the ART procedures, including gynecologists, andrologists, embryologists, biologists, geneticists, oncologists, and microbiologists, called "InfertilItaly group", used available evidence to develop this expert position.

Outcomes: Starting from the individuation of the principal risk factors that may influence the fertility of females and males and both genders, the work group identified most appropriate procedures using a gradual approach to both partners aimed to obtain a precise diagnosis and the most effective therapeutic option, reducing invasive and occasionally redundant procedures.

Conclusions: This expert position provides current knowledge on risk factors and suggests a diagnostic workflow of infertile couples. By using this step-by-step approach, health care workers involved in ART, may individuate a practical clinical management of infertile couples shared by experts.

Keywords: assisted reproductive technlogy; couple infertility; diagnosis; female infertility; infertility diagnosis; male infertility; management; reproduction.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Infertile couple flow chart.
Figure 2
Figure 2
Possible alteration observable during trans-vaginal ultrasound.
Figure 3
Figure 3
Gynecological specific flow chart: second level diagnostic investigation and possible therapeutic approach for woman with no known risk factors.
Figure 4
Figure 4
Gynecological specific flow chart: second level diagnostic investigation and possible therapeutic approach for woman with <35 years.
Figure 5
Figure 5
Gynecological specific flow chart: second level diagnostic investigation and possible therapeutic approach for woman with >35 years.
Figure 6
Figure 6
Andrological specific flow chart: microbiological assessment in male with anomalies found in infertility counseling.
Figure 7
Figure 7
Andrological specific flow chart: diagnostic investigation for man with azoospermia, cryptozoospermia, and severe oligozoospermia (<5 total million).
Figure 8
Figure 8
Andrological specific flow chart: diagnostic investigation for man with moderate oligozoospermia (5–39 total million).
Figure 9
Figure 9
Andrological specific flow chart: diagnostic investigation for man with asthenozoospermia.
See this image and copyright information in PMC

References

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