Introduction

The incidence of female infertility is age- and parity-related. In a national government survey conducted in 2002, 7.4% of all married women in the United States, aged 15–44, reported difficulty becoming pregnant during the previous year. The incidence of infertility ranged from a low of 4% in previously pregnant women aged under 30, to 27% in never-pregnant women aged 40–44. In a previous survey of the same population, 35% of women who sought medical help were treated with ovulation induction (OI), 13% with husband or donor intrauterine insemination (IUI) and 1.7% with in-vitro fertilization (IVF) or other advanced assisted reproductive technology (ART). Similar infertility rates are reported elsewhere in the Western world, with the availability of infertility treatment facilities and the use of IVF varying both between and within countries. In 2003, IVF was responsible for 6.5% of live births in Denmark and 3% of all live births in Europe, compared to 1.2% of live births in the United States. Patients in the United States with private health insurance were four times more likely to receive OI and three times more likely to have IUI than patients without insurance, but no more likely to have IVF than patients without insurance.

The causes of infertility in 14,141 couples, from reports compiled in 1995, were ovulatory disorder 27%, abnormal semen 25%, tubal occlusion 22%, endometriosis 5% and unexplained 17%.