The process of decision making in reproductive medicine.

The decision-making process regarding the optimal infertility treatment strategy is influenced by several factors. In addition to the underlying cause of infertility, the process of decision making is also influenced by other factors. These factors are mainly (1) the duration of infertility, (2) patient's age, and (3) the number of previously performed treatment cycles of intrauterine insemination (IUI) or in vitro fertilization (IVF). The duration of infertility influences diagnostic steps as well as therapeutic options. With an infertility of at least 5 years the benefit of intrauterine insemination is limited and couples should be counseled to go forward with IVF. Patients age >or= 40 years should be treated with IVF, whereas patients age >or= 43 years should be counseled about their very limited chance to conceive even through IVF. The number of insemination cycles should be limited to four. Couples who have undergone at least six IVF cycles should be counseled to discontinue therapy. The treatment program should be as individualized as possible, with individual counseling that is adapted after each single treatment cycle.