Chapter 31: Management of Fertility and Infertility

The first section addresses contraceptive decision-making, establishing that effective family planning requires assessing safety profiles, efficacy rates, ease of adherence, and protection against sexually transmitted infections to match individual patient circumstances. The text systematically reviews contraceptive options across multiple categories: permanent methods including tubal ligation and vasectomy; long-acting reversible contraceptives such as intrauterine devices and subdermal implants; hormonal contraception including combined oral contraceptives, progestin-only formulations, transdermal patches, and vaginal rings, with emphasis on mechanisms of action like ovulation suppression and recognition of serious adverse effects signaled by the ACHES warning signs; and barrier techniques alongside behavioral approaches including condoms, diaphragms, cervical caps, natural family planning, abstinence, and lactational amenorrhea. The chapter addresses unique counseling needs for adolescents requiring confidential guidance and perimenopausal women navigating reduced fertility. The second major section explores infertility management, defined as failure to achieve conception following one year of unprotected intercourse. Male factor infertility encompasses sperm abnormalities and erectile dysfunction, while female factor infertility includes anovulation, polycystic ovary syndrome, tubal obstruction, and structural abnormalities. Diagnostic evaluation progresses from semen analysis through imaging studies including hysterosalpingography. Therapeutic options range from pharmacological ovulation stimulation and timed insemination to advanced assisted reproductive technologies including in vitro fertilization, gamete intrafallopian transfer, and intracytoplasmic sperm injection. The chapter concludes by addressing the psychological dimensions of infertility, ethical frameworks surrounding surrogacy and gamete donation, and the emotional pathways toward adoption or acceptance of childlessness.