The management of infertility: where to stop.

Many empirical traditional treatments for infertility may improve various fertility parameters but have no proven effect on clinical fertility. Diagnosis and management of ovulation disorders can be undertaken by most gynaecologists and the results are relatively good. Effective treatment for male infertility is poor and largely empirical, and artificial insemination by donor (AID) remains the mainstay of management. Tubal infertility may be overcome by surgery, particularly microsurgery, in selected cases especially sterilization reversal with minimal damage. Severe tubal disease is best managed by effective in vitro fertilization (IVF) programmes. Criteria of selection for IVF treatment include ovarian accessibility at laparoscopy and a normal semen sample. As many of the new techniques are difficult and contentious the decision to accept, reject or discontinue treatment should be made by the couple themselves after they have received a full and unbiased appraisal of their problem and its chance of successful management.