ACTIVITY NUMBER:  RES013

ACTIVITY TITLE: Infertility Evaluation

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

Expiration Date: August 14, 2019    

Reviewed:  2016

Under Review July 2022

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 regards to age and geographic location.³   In addition, there is 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.  Treatments discussed include nongonadotropin therapies and the role of selected surgical procedures.   Also discussed are indications for referral to a board-certified reproductive endocrinologist and counseling for patients regarding their prognosis and options for family building.   

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

2.       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.

3.       Glatstein IZ, Harlow BL, Hornstein MD. Practice patterns among reproductive endocrinologists: the infertility evaluation. Fertil Steril. 1997 Mar;67(3):443-51.

4.       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 the 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.

4.      Describe appropriate treatment for infertile patients who have irregular ovulation  with  nongonadotropin  therapy.

5.      Describe appropriate surgical procedures to correct anatomic conditions that cause infertility.

6.      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.

7.      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 and gynecology and other 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:

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

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

·        Be given the option of downloading a printed syllabus containing the presentation and narrative.

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

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

·        Complete the evaluation survey.

·        Print certificate of completion.

DISCLOSURES FOR PLANNERS AND FACULTY 

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

Bradley S. Hurst, MD – 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

Ellen Wilson, MD – Nothing to Disclose

Bo Yu, MD – Nothing to Disclose

It is the policy of the ASRM to ensure balance, independence, objectivity, and scientific rigor in all its educational activities. All faculty/authors participating in this activity were required to disclose any relationships they may have with commercial entities whose products or services are used to treat patients so that participants may evaluate the objectivity of the presentations. The content and views presented in this activity are those of the faculty/authors and do not necessarily reflect those of the ASRM or CREOG. Any discussion of off-label, experimental, or investigational use of drugs or devices will also be disclosed. The disclosure statements were reviewed by the Subcommittee for Standards of Commercial Support of the CME Committee of ASRM and any perceived conflicts of interest were resolved in accordance with the policies of the ACCME.

STATEMENT OF SUPPORT

No commercial support has been provided for this activity.