Infertility is defined as failure to achieve pregnancy after 12 months or more of regular, unprotected intercourse. Infertility is presumed after 12 months when the female partner is younger than 35 years, and after 6 months when the female partner is older than 35 years. Couples attempting to conceive should be encouraged to engage in intercourse every 1 to 2 days and can track ovulation to maximize the likelihood of conception. Evaluation of male infertility should include assessment for underlying medical conditions that may affect fertility and at least one semen analysis. Approximately 25% of couples have unexplained infertility. Assisted reproductive technology can be used to achieve pregnancy, including for couples who do not have an identified cause of infertility. Low libido in men is a poorly understood phenomenon that is underdiagnosed in clinical practice. The degree of distress associated with lack of sexual desire is essential to the diagnosis. The Sexual Desire Inventory-2 can be used to initiate discussion with patients and assess libido. Clinicians should rule out factors that can contribute to low libido (eg, endocrinopathies, testosterone deficiency, mental health conditions, relationship issues) and support patients in achieving their goals regarding sexual health. Testosterone replacement therapy should be considered for men with low libido and testosterone deficiency.

Infertility

Case 1. RM and TM, a male-female married couple, present to your office after attempting to conceive for the last 14 months. The male partner RM is 28 years old, and the female partner TM is 29 years old. She stopped using contraception 2 years ago. They have penetrative intercourse every 3 to 4 days throughout the month. They are both healthy and use no medications, and neither has had a child previously nor experienced pregnancy loss. They share that their increasing frustration with the situation is affecting their relationship.