EPIDEMIOLOGIC APPROACHES TO INFERTILITY

There are a number of reasons why epidemiological approaches to infert ility have not made a major contribution to research in Australia. The y include the success of generic treatments, the high public profile o f infertility and the consequent polarization of discussion over treat ment 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 epid emiology. Voluntary infertility is now common for most of the fertile life span in developed countries, and intended family size is small. M any important conditions cannot be diagnosed without the use of invasi ve procedures or complex investigations, and the more widespread use o f less invasive procedures has shown other conditions to be relatively common in healthy populations. If epidemiological approaches are to m ake a greater contribution towards an increased understanding and cont rol of infertility, research should focus on retrospective and prospec tive cohort studies of the incidence and prevalence of infertility, ne sted case-control studies of occupational and environmental exposures, and an extension of the developing use of record-linkage across routi nely collected data systems and registers.