Definitions of infertility and recurrent pregnancy loss: a ...

1 Definitions of infertility and recurrentpregnancy loss: a committee opinionPractice Committee of the American Society for Reproductive MedicineAmerican Society for Reproductive Medicine, Birmingham, AlabamaThis document contains the Definitions of infertility and recurrent pregnancy loss as defined by the Practice Committee of the American So-ciety for Reproductive Medicine. It replaces the document, Definitions of infertility and recurrent pregnancy Loss: a Committee Opinion, last published in 2013 (Fertil Steril 2013;99:63). (Fertil Steril 2020;113:533 5. 2019 by American Society for Reproductive Medicine.)El resumen est disponible en Espa ol alfinal del art :You can discuss this article with its authors and other readers is categorized as a diseaseby the World Health Organization, adesignation supported by numerousprofessional associations including theAmerican Medical Association, theEuropean Society for Human Repro-duction and Embryology, the Interna-tional Committee for MonitoringAssisted Reproductive Technologies(ICMART) and the American Societyfor Reproductive Medicine (1 4).

2 infertility is a disease* historicallydefined by the failure to achieve a suc-cessful pregnancy after 12 months ormore of regular, unprotected sexualintercourse or due to an impairmentof a person s capacity to reproduceeither as an individual or with her/his is a disease which gener-ates disability as an impairment offunction. Diagnostic testing for infer-tility should be initiated without delayupon presentation in any patient witha medical history, sexual or reproduc-tive history, advanced age or physicalfindings that suggest the possibility ofimpaired reproductive function. In theabsence of exigent history or physicalfindings, evaluation should, andtreatment may be, initiated at 12months in women under 35 years ofage and at 6 months in women age 35or older. In women over 40 more imme-diate evaluation and treatment may bewarranted (2).

3 Donor Insemination is the processof placing laboratory-processed sperminto the reproductive tract of a womanfrom a man who is not her intimatesexual partner for the purpose of initi-ating a pregnancy (2). Cycle fecundityis significantly lower when donorinsemination is performed usingcryopreserved donor sperm whencompared to use of fresh sperm (5).In individuals or couples using cryo-preserved donor sperm who fail toachieve pregnancy considerationshould be given to performing anevaluation and initiating treatmentsooner than 12 months for women un-der 35 years of age and 6 months forwomen age 35 or pregnancy loss is adisease distinct from infertility ,defined by the spontaneous loss oftwo or more pregnancies. With dis-ease being defined perDorland sIllustrated Medical Dictionary(29thed) as, any deviation from orinterruption of the normal structureor function of any part, organ, orsystem of the body as manifestedby characteristic symptoms andsigns; the etiology, pathology , andprognosis may be known or un-known (6).

4 Each pregnancy lossmerits careful review to determinewhether specific evaluation of thewoman or couple may be appro-priate (2).Acknowledgments:This report wasdeveloped under the direction of thePractice Committee of the AmericanSociety for Reproductive Medicine asa service to its members and otherpracticing clinicians. Although thisdocument reflects appropriate man-agement of a problem encountered inthe practice of reproductive medicine,it is not intended to be the onlyapproved standard of practice or todictate an exclusive course of treat-ment. Other plans of managementmay be appropriate, taking into ac-count the needs of the individual pa-tient, available resources, andinstitutional or clinical practice limita-tions. The Practice Committee and theBoard of Directors of the AmericanSociety for Reproductive Medicinehave approved this document was reviewed byASRM members and their input wasReceived November 19, 2019; accepted November 20, : Practice Committee, American Society for Reproductive Medicine, 1209 Montgom-ery Highway, Birmingham, Alabama 35216 and Sterility Vol.

5 113, No. 3, March 2020 0015-0282/$ 2019 American Society for Reproductive Medicine, Published by Elsevier 113 NO. 3 / MARCH 2020533 ASRM PAGES considered in the preparation of thefinal document. Thefollowing members of the ASRM Practice Committeeparticipated in the development of this document. AllCommittee members disclosed commercial andfinancialrelationships with manufacturers or distributors of goodsor services used to treat patients. Members of the Com-mittee who were found to have conflicts of interestbased on the relationships disclosed did not participatein the discussion or development of this Penzias, ; Kristin Bendikson, ; TommasoFalcone, ; Karl Hansen, , ; Micah Hill, ;William Hurd, , ; Sangita Jindal, ; SuleenaKalra, , ; Jennifer Mersereau, ; CatherineRacowsky, ; Robert Rebar, ; Richard Reindollar, ; Anne Steiner, , ; Dale Stovall, ;Cigdem Tanrikut, World Health Organization.

6 infertility Definitions and terminology. Accessibleat: November 16, F, Adamson GD, Dyer S, Racowsky C, de Mouzon J,Sokol R, et al. The International Glossary on infertility and Fertility Care,2017. Fertil Steril 2017;108:393 European Society of Human Reproduction and Embryology. ESHRE: A policyaudit on fertility: Analysis of 9 EU countries; March 2017. Available at: Accessed February 13, American Medical Association. AMA backs global health experts in callinginfertility a disease. Accessible at: AccessedNovember 16, LL, Adamson GD, Boltz NL. Therapeutic donor insemination: a prospec-tive randomized trial of fresh versus frozen sperm. Am J Obstet Gynecol 1992;166:1597 Dorland's Illustrated Medical Dictionary. 29th Edition. Philadelphia: Saunders; 113 NO. 3 / MARCH 2020 ASRM PAGESD efiniciones de infertilidad y p erdida recurrente del embarazo: una opini on del comit eEste documento contiene las definiciones de infertilidad y p erdida recurrente de embarazo seg un lo definido por el Comit edePr actica dela Sociedad Americana de Medicina Reproductiva.

7 Reemplaza el documento, Definiciones de Infertilidad y P erdida Recurrente de Em-barazo: una opini on del Comit e, publicado por ultima vez en 113 NO. 3 / MARCH 2020535 Fertility and Sterility