ACTIVITY NUMBER: RBP013

ACTIVITY TITLE: Infertility Evaluation and Treatment

ACCREDITATION STATEMENT

The American Society for Reproductive Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Release Date: August 15, 2016
Reviewed:  Aug 2016, July 2022, Sept 2025 
Expiration Date: March 31, 2029   

Estimated Time to Complete Activity: 1.0 hour

NEEDS ASSESSMENT and IDENTIFICATION OF PRACTICE GAP

Infertility is a disease defined by the failure to achieve a successful pregnancy after 12 months or more of regular unprotected intercourse. Earlier evaluation and treatment may be justified based on medical history and physical findings, and is warranted after 6 months for women over age 35 years.¹   Infertility affects about 7.3 million women and their partners in the U.S., about 12% of the reproductive-age population.²  A basic infertility evaluation of the couple is essential to determine the cause(s) and the appropriate treatment or need for referral.  Unfortunately, there are limited data from rigorous, controlled, clinical trials evaluating the efficacy of infertility screening tests in relation to clinical outcome, leading physicians to use other sources of guidance for their clinical practice decisions.³   Surveys of practicing board-certified reproductive endocrinologists have shown variability in the details of the performance of most testing and practice pattern differences, especially with regard to age and geographic location.³   In addition, there is a lack of agreement on the roles of newer and more controversial modes of testing.⁴

This presentation addresses the causes of primary and secondary infertility, with guidance for performing a pertinent physical examination and patient history.  The presentation also covers the basic diagnostic tests for assessing the most common causes of infertility and their interpretation. 

Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss.  Fertil Steril. 2008 Nov;90(5 Suppl):S60.

1. Centers for Disease Control and Prevention, National Center for Health Statistics. 2002 National Survey of Family Growth. U.S. Department of Health and Human Services Web site. 
2. Glatstein IZ, Harlow BL, Hornstein MD. Practice patterns among reproductive endocrinologists: the infertility evaluation. Fertil Steril. 1997 Mar;67(3):443-51.
3. Glatstein IZ, Harlow BL, Hornstein MD. Practice patterns among reproductive endocrinologists: further aspects of the infertility evaluation.  Fertil Steril. 1998 Aug;70(2):263-9.

This educational activity is designed to address the Unit 5 Reproductive Endocrinology educational objectives from the Council on Resident Education in Obstetrics and Gynecology (CREOG) on this topic.

EDUCATIONAL OBJECTIVES

At the conclusion of Part I of this educational activity, participants should be able to:

1. Describe the classification and principal causes of infertility.
2. Elicit a pertinent history and list the components of a focused physical examination to evaluate infertility.
3. Select and interpret diagnostic tests to determine the most likely cause of infertility.

At the conclusion of Part II of this educational activity, participants should be able to:

1. Describe appropriate treatment for infertile patients who have irregular ovulation with nongonadotropin therapy.
2. Describe appropriate surgical procedures to correct anatomic conditions that cause infertility.
3. Counsel patients about the prognosis for their condition and alternatives to childbearing, such as adoption, donor gametes, and use of a surrogate or gestational carrier.
4. Describe the indications for referral to a subspecialist for treatment.

TARGET AUDIENCE

This activity is designed to meet the educational needs of resident physicians in obstetrics, gynecology, and related specialties. 

ACGME COMPETENCIES

Medical Knowledge

Patient Care

Interpersonal and Communication Skills

SUCCESSFUL COMPLETION REQUIREMENTS

Successful completion of this educational activity requires the learner to:

·         Prior to the start of each module, view a course overview page containing all CME and disclosure information, including acknowledgement of commercial support and disclosure of unlabeled use. 

·         Complete a 10-question pre-exam prior to the module. Learners should note any pre-exam questions answered incorrectly for clarification during module study. 

·         Complete a 10-question post-exam, with feedback of correct/incorrect answers, scoring a minimum of 70% in two attempts.

·         Be given the option of downloading materials supporting the presentation.

·         Participate in the interactive activity: Audio narration is synchronized with visual elements that can be advanced, stopped or reversed as desired.

·         Complete the evaluation survey. 

·         Print certificate of completion.

DISCLOSURE STATEMENT

It is the policy of ASRM to ensure balance, independence, objectivity, and scientific rigor in all its educational activities. All faculty/speakers participating in this activity are required to disclose any relationships they may have with companies whose products or services could be mentioned, allowing participants to determine the objectivity of the presentations. The content and views presented in this activity are those of the faculty/speakers and do not necessarily reflect those of ASRM. Any discussion of the off-label, experimental, or investigational use of drugs or devices is not allowed. The disclosure statements were reviewed by the CME Subcommittee and the Executive Program Committee of ASRM, and any perceived conflicts of interest were resolved in accordance with the ACCME’s policies and Standards of Integrity and Independence in Accredited Continuing Education.

PRIOR CONTRIBUTORS AND REVIEWERS

Ruben J.  Alvero, MD – Nothing to Disclose

Alicia Y. Armstrong, MD  – Nothing to Disclose

Valerie Baker, MD  – Institutional Support from IBSA

Nancy A. Bowers, BSN, RN, MPH  – Nothing to Disclose

Bruce R. Carr, MD – Research support from Wyeth, Neurocrine, Boehringer Ingelheim; Consultant for Novo Nordisk 

Marcelle I. Cedars, MD  – Nothing to Disclose

Marc Goldstein, MD – Advisory Board: Theralogix

Elizabeth A. Grill, PsyD – Nothing to Disclose

Andrew R. La Barbera, PhD, HCLD  – Nothing to Disclose

Lawrence C. Layman, MD – Nothing to Disclose

Meredith Loveless, MD – Nothing to Disclose

Janet McLaren, MD – Nothing to Disclose

Patricia M. McShane, MD – Nothing to Disclose

Shona C. Murray, MD - Nothing to Disclose

Steven T.  Nakajima, MD –Consultant, research support, speaker’s bureau for Warner Chilcott; Stockholder for IntegraMed

Staci E. Pollack, MD – Nothing to Disclose

Randal D. Robinson, MD - Speaker’s bureau for Merck and Teva

Richard H. Reindollar, MD – Nothing to Disclose

Nanette Santoro, MD – Consultant for QuatRx

James H. Segars, MD – Nothing to Disclose

Mary D. Stephenson, MD, MSc –  Consultant for NoraTherapeutics

Kim L. Thornton, MD – Consultant for Parexel

James P. Toner, M.D., Ph.D. -  Research support from Columbia Laboratories

Mark Trolice, MD – Cryos International – Paid Consultant (Self); Alto Pharmacy – Direct Stockholder (Self)

Ellen Wilson, MD – Nothing to Disclose

Bo Yu, MD – Nothing to Disclose

2025 CONTENT DEVELOPERS

Heather Burks – Pacific Coast Reproductive Society – Board of Directors (Self)

LaTasha Craig — Ferring Pharmaceuticals – Paid Consultant (Self)

Rani Fritz, MD – Cradle Genomics – Medical Advisory Board (Self)

Ryan Heitmann –  Nothing to Disclose

Sarah Hmaidan – Nothing to Disclose

Bradley S. Hurst, MD – Nothing to Disclose

Patricia Jiminez, MD – Society for Reproductive Investigation – Member of DEI, Early Career, and CME committee*

Molly Kornfield – Nothing to Disclose

Dab Lebovic – Ferring Pharmaceutical – Paid Consultant (Self)

Nora Miller, MD – Nothing to Disclose

Ariya Mobaraki, MD – Nothing to Disclose

Amalia Namath, MD – Nothing to Disclose

Chioma Ogbejesi – Nothing to Disclose

Pamela Parker, MD – Nothing to Disclose

Jensen Reckhow, MD – Nothing to Disclose

2025 COURSE REVIEWERS (* beta-test participant reviewer; not responsible for content)

Heather Hipp, MD – Nothing to Disclose

Paul Lin, MD - Nothing

Winifred Mak, MD – Nothing to Disclose *

Pamela Parker, MD – Nothing to Disclose

Julie Rios, MD – Nothing to Disclose *

Divah Shah, MD – Nothing to Disclose

Mark Trolice, MD – Cryos Internation – Paid Consultant (Self); Alto Pharmacy – Direct Stockholder (Self)

David Walker – Nothing to Disclose

ADDITIONAL PRESENTERS AND RESOURCES

Tara Harding, DNP, FNP - Nothing to Disclose

Leslie King, BS, MSN, NP - Nothing to Disclose

Molly Kornfield, MD - Nothing to Disclose

Melanie Mikkelsen, MSW, LICSW – Hold Hope Inc, Owner

Jensen Reckhow, MD - Nothing to Disclose

Julie Rios, MD - Nothing to Disclose

Anne Steiner, MD - Nothing to Disclose

Michelle Vu, MD - Nothing to Disclose

Zachary Walker, MD -Nothing to Disclose

James Wren, MD - [Check Disclosure]

ASRM STAFF PLANNERS AND DEVELOPERS

Deidra Cain, DrPH, EdD – (former staff)

Michelle Landrum, EdD – (former staff)

Chevis Shannon, DrPH, MBA – Nothing to Disclose

Harriet Smith, M.Ed - Nothing to Disclose

STATEMENT OF SUPPORT

No commercial support has been provided for this activity.