Infertility management
- 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, progesterone 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.