Infertility management and when to refer
Check
- Female rubella status
- Taking folic acid
- Weight gain if anovulatory
- Occupational and drug history
- Cervical smear history
Advice
- Weight loss if BMI is more than 28
- Stop smoking
- Minimal alcohol and caffeine intake
- Regular intercourse (2-3 times a week)
Investigations
- Length of cycles, progresterone 6-8 days before menses
- FSH and estradiol day 2-4 of cycles
- Semen analysis – repeat in 4-6 weeks unless totally normal
- Prolactin and thyroid function only if irregular cycles
Further investigation (Required for public patients)
- Laparoscopy if duration more than one year, unless severe ovulation or sperm factor
Referral
- No success after 12 months unprotected intercourse
- Any abnormal results on investigation
Early referral if
- Extreme anxiety about fertility
- Woman more than 35 years of age
- Ovulation factor
- Severe sperm factor
- Previous abdominal / pelvic / urogenital surgery
- Previous Sexually transmitted infection / Pelvic inflammatory disease
- Recurrent miscarriage (two or more consecutive miscarriages)
- Abnormal pelvic / genital examination (woman or man)
- Family history of menopause of less than 40 years of age
- Significant systemic illness
- Genetic conditions (eg. Cystic fibrosis, muscular dystrophy or Huntington's disease)
Immediate Referral for
Sperm, egg, ovarian tissue or testicular tissue stored before starting cancer treatment.