Definition of Infertility and Indications for Fertility Evaluation: Consensus Document

Monica Minjeur; Tracey Parnell; Joseph Stanford; Phil Boyle; José Antonio Arraztoa; Zoreslava Horodenchuk; Natalia Suszczewicz; Kevin McCarthy

doi:10.63264/zvpr3e66

Clinical Guidelines and Standards · Diagnostic Criteria and Classification

Definition of Infertility and Indications for Fertility Evaluation: Consensus Document

Minjeur M, Parnell TA, Stanford JB, Boyle PA, Arraztoa JA, Horodenchuk Z, Suszczewicz N, McCarthy K

Published July 13, 2026 Journal of Restorative Reproductive Medicine

DOI 10.63264/zvpr3e66

RRM Academy Synopsis

Consensus document defines infertility as a sign of pathology

A 2026 consensus paper from a restorative medicine group says infertility is a symptom of an underlying problem in one or both partners. The paper gives three ways to diagnose infertility. It also lists cases that warrant evaluation with or without a diagnosis, like irregular cycles.

Key Findings

The document defines infertility as the symptom of being unable to conceive or sustain a pregnancy, and reads that symptom as a sign of male and/or female pathology.
A clinical diagnosis is made at 12 months of non-contracepted intercourse, at 6 cycles of fertility-timed intercourse, or with a medically identified condition making pregnancy unlikely or impossible.
The document lists irregular cycles or suspected anovulation at any age, and two or more losses without a live birth, as warranting evaluation whether or not infertility is diagnosed.
For women aged 35 years to 39 years, it lists 6 cycles of non-contracepted intercourse without conception as warranting evaluation. A miscarriage does not restart the count of cycles or months.
About 2,500 individuals and 44 organizations in 92 countries were invited to review the proposed document. Reviewers' input led to 3 substantive edits, 18 minor edits and 15 citation corrections.

Interpretation

This is a position and policy document. The authors reviewed published literature and gathered stakeholder comments. The paper says a diagnosis based on time trying rests on probability: about 50% of couples may conceive within the following 6-12 months without evaluation. The findings support wider discussion of how that probability threshold shapes when couples are referred for evaluation.

RRM Context

Restorative reproductive medicine begins by asking why conception is not happening. The definition builds that question in. Its criteria count fertility-timed intercourse, which fits the cycle charting many couples do. The World Health Organization definition rests on 12 months of trying. A pathology-based definition changes what triggers evaluation for both partners.

Our editorial summary of this paper, not the article's abstract.

Abstract

Infertility is a clinical condition that is recognized by the symptom of an inability to conceive through sexual intercourse or to sustain a pregnancy, with that symptom indicating underlying male and/or female pathology.

Methodology

This definition of infertility was developed through a structured, consensus-informed process involving broad stakeholder engagement. Initially, multiple definitions currently used by various medical professional organizations were reviewed, and a definition document was drafted and submitted to the Board of Directors of the International Institute for Restorative Reproductive Medicine (IIRRM). All IIRRM members were invited to provide feedback on the draft. Approximately 2,500 individuals and 44 organizations from 92 countries were then invited to review the proposed document, representing clinical, scientific, patient, policy, and advocacy perspectives. Submitted comments were reviewed thematically, with suggested revisions evaluated for clarity, clinical relevance, inclusiveness, and consistency with contemporary restorative reproductive medicine. Following this review, 3 substantive changes, 18 minor changes, and 15 citation corrections were incorporated into the final draft which resulted in a revised definition intended to better reflect the medical, social, and practical realities of modern infertility evaluation and care. Final approval by the IIRRM Board of Directors was unanimous.

Topics

Clinical Guidelines and Standards Diagnostic Criteria and Classification Terminology and Definitions

Clinical Guidelines and Standards › Diagnostic Criteria and Classification › Terminology and Definitions

Monica Minjeur, Tracey Parnell, Joseph Stanford, Phil Boyle, José Antonio Arraztoa, Zoreslava Horodenchuk, Natalia Suszczewicz, Kevin McCarthy

M Minjeur, T Parnell, Joe Stanford, Joey Stanford, J Stanford, Philip Boyle, Phillip Boyle, P Boyle, J Arraztoa, Z Horodenchuk, N Suszczewicz, K McCarthy

DOI 10.63264/zvpr3e66 10.63264/zvpr3e66 Minjeur et al. 2026, Minjeur 2026

Definition of Infertility and Indications for Fertility Evaluation: Consensus Document

Consensus document defines infertility as a sign of pathology

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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