Infertility

Infertility is the absence of pregnancy in a couple after 12 months or more of regular intercourse without contraception. The World Health Organization uses this 12-month definition and classifies infertility as a disease of the male or female reproductive system.¹ Many clinicians begin testing sooner, after 6 months, when the woman is 35 or older. That earlier start guides when a workup begins. It does not change the definition. The World Health Organization estimates that infertility affects approximately 17.5% of adults worldwide, or roughly 1 in 6 people.² Primary infertility describes couples who have never conceived. Secondary infertility describes couples who have conceived before but cannot conceive again. See Secondary Infertility for the distinct clinical picture of that condition.

In the RRM framework, infertility is a symptom. The 12-month mark signals that a couple needs a workup. The condition behind the delay is what requires a diagnosis. The label unexplained infertility means the workup has not yet found the cause. RRM regards that label as a sign of an unfinished evaluation.

The causes can lie with either partner, or with both. A male factor is the only cause in about 20% of couples. It contributes alongside female factors in another 30 to 40%. Sperm damage from oxidative stress is one known cause behind many of these cases.³ A couple-based workup evaluates both partners from the first visit. See Male Factor Infertility and Semen Analysis.

In women, common identifiable causes include endometriosis, polyendocrine metabolic ovarian syndrome (PMOS / PCOS), luteal phase deficiency, and tubal factor. They also include thyroid disorders and hormone disorders found through cycle-timed testing. RRM regards each of these as a treatable root cause. The goal is to find the cause and correct it, rather than bypass it. A thorough evaluation maps the cause before any treatment begins.