Infertility Treatment Menstrual cycle disorders are not uncommon in women with CHD. In small case series of women with CHD, var- ious causes for infertility were documented including primary and secondary amenorrhea, oligomenorrhea, and uterine anomalies.S3.13.3-1,S3.13.3-2 In more complex forms of CHD (eg, the population with Fontan pallia- tion), the prevalence of primary amenorrhea may be as high as 40%.S3.13.3-2 Menarche occurs at an older age in these women than in the general population.S3.13.3-2 Women with CHD also have higher rates of spontane- ous abortion and miscarriage.S3.13.3-3 S3.13.3-5 The preva- lence of infertility in men with CHD is unknown. Each patient with ACHD should be counseled regarding the potential for infertility and referral to a specialized re- productive endocrinologist when appropriate, although there is little specific guidance for women based on types of CHD. Alternative options for family planning including assisted reproductive technologies and adop- tion is appropriate, and risks versus benefits of all op- tions are addressed during counseling. 3.13.4. Sexual Function Sexuality is an important element of QoL. Although there are data that sexual function is a concern in both women and men, there is minimal evidence on the prevalence of sexual concerns among adults with CHD and far less to guide interventions.S3.13.4-1 Concerns with sexual health are present in 20% to 40% of men with CHD.S3.13.4-2 S3.13.4-4 Erectile dysfunction is reported by up to 42% of men with CHD.S3.13.4-1,S3.13.4-3 Men with CHD report being in sexual relationships sig- nificantly less often than the general population.S3.13.4-1, Among men with CHD who report sexual health concerns, there is a high level of psychological dis- tress and diminished QoL.S3.13.4-1,S3.13.4-2,S3.13.4-4,S3.13.4-5 The ACHD provider should be mindful of this often-unspoken concern and create an environment in which the patient feels comfortable addressing concerns about their sexuality. 