Epidemiological approaches to infertility

Abstract

There are a number of reasons why epidemiological approaches to infertility have not made a major contribution to research in Australia. They include the success of generic treatments, the high public profile of infertility and the consequent polarization of discussion over treatment versus prevention, some reluctance to draw attention to possible aetiologic factors which may be perceived negatively in public debates, and the lack of graduate training in reproductive and perinatal epidemiology. Voluntary infertility is now common for most of the fertile life span in developed countries, and intended family size is small. Many important conditions cannot be diagnosed without the use of invasive procedures or complex investigations, and the more widespread use of less invasive procedures has shown other conditions to be relatively common in healthy populations. If epidemiological approaches are to make a greater contribution towards an increased understanding and control of infertility, research should focus on retrospective and prospective cohort studies of the incidence and prevalence of infertility, nested case-control studies of occupational and environmental exposures, and an extension of the developing use of record-linkage across routinely collected data systems and registers.