ABSTRACT
In the UK, demands on fertility services are likely to increase. Changing sexual lifestyles are leading to increasing incidence of sexually transmitted diseases, some of which contribute to subfertility. In addition, women are delaying childbearing. Since 1975, there has been a doubling in the proportion of births to women age 30 and over in England and Wales. We know that one in six couples require referral for investigation and/or treatment for subfertility. Recent guidelines published by the National Institute for Clinical Excellence (NICE) and further comments by the Secretary of State for Health have made couples more aware of what may be available, although this often leads to falsely high expectations both of fertility treatments and of service provision. Natural human fertility is low compared with most other species. Peak human fertility (the chance of pregnancy per cycle in the most fertile couples) is no higher than 33%. Because of this, it is quite unrealistic for couples to expect (1) a higher chance of pregnancy than this from any fertility treatment, and (2) considerable effort on the part of scientists and clinicians to try to do so.
