Abstract
Issues relevant to the current management of female infertility include the aging female infertile population and the obesity epidemic. Diagnosis is straightforward when causes are severe and laparoscopy is still the preferred method for assessing for tubal factor infertility and endometriosis. Laparoscopy can be timed to take advantage of the spontaneous pregnancy rate that exists mainly in unexplained infertility. IVF remains the dominant treatment, although traditional measures still have a major role. Internationally, IVF opportunities are limited in view of cost. The New Zealand system offers a prioritization system that enables public access to IVF for couples most in need and for those most likely to benefit.
Acknowledgements
The author would like to thank Dr John Peek from Fertility Associates, New Zealand, for providing material for this review.
Notes
Hysterosalpingography may be used to test tubal patency. Laparoscopy is the gold-standard test for tubo–peritoneal disease and is the preferred method, especially when evaluation of the pelvis is required. If there is a severe semen defect then there is no need for laparoscopy unless indicated for other gynecological reasons (or following failed DI treatment). Furthermore, for ovarian defects, a trial of therapy is indicated before laparoscopy is considered. DI: Donor insemination; PID: Pelvic inflammatory disease.