The subfertile couple

Subfertile couples are those who require medical help to achieve pregnancy after trying unsuccessfully for a variable period of time. Although the term ‘subfertility’ is also occasionally used in the context of women who can conceive but suffer recurrent miscarriages, this aspect is outside the scope of this review. Subfertility can seriously affect mental and social well-being. It is not generally viewed as a disease that significantly causes physical ill health, though it may be an early manifestation of serious coexisting disease. Advances in assisted reproductive technology in the last 22 years have simplified and diversified treatment options, rendering the terms ‘infertility’ and ‘sterility’ unfashionable. As a result, there is now an unfortunate trend towards only a superficial medical history and perfunctory physical examination. There are many guidelines on the initial investigation and subsequent management of subfertile couples, and it is now relatively easy to help them to achieve pregnancy. However, dealing with the devastating news of causative factors such as azoospermia, genetic disease, congenital anomaly and premature ovarian failure can be difficult. To discuss these sympathetically, professionals require interpersonal skills in breaking bad news. A multidisciplinary team approach should be adopted to cater for the long-term health consequences when co-morbidities are detected.