Subfertility

Differential diagnosis

• Ovulation problems – PCOS
• PID – prev STI, PV discharge
• Fallopian tube dysfunction
• Lifestyle – smoking, alcohol

Data gathering

• General
  • duration of trying to conceive
  • frequency of intercourse
  • smoking, alcohol
  • previous STIs
• Female
  • periods
  • previous pregnancies
  • previous abdominopelvic surgery
• Male
  • previous children
  • undescended testes
  • varicocele,
  • scrotal surgery
  • infections – mumps, orchitis
• Examination
  • BP, weight, height
  • abdo, genitalia, acne/hirsutism

Clinical management

• Investigations
  • Bloods – progesterone (7d before period), LH/FSH/Oestradiol (D2-D7), Rubella, HIV, HBV, HCV, TFTs
  • Chlamydia/Gonorrhoea urine NAAT
  • Pelvic USS
  • Cervical screening
  • Semen analysis (+HBV, HCV and HIV of male)

• Explanation
  • 8 of 10 will conceive within one year. Various reasons for difficulties conceiving – if lifestyle measures fail, can refer to fertility specialist

• Treatment
  • Lifestyle – smoking cessation, alcohol reduction, healthy diet, weight loss, exercise
  • Sexual intercourse every 3 days
    • avoid body temperature charts
  • Folic acid
  • Abnormal semen sample
    • repeat after 3 months

• Follow-up / Safety-net
  • Refer to fertility clinic if not pregnant after 1 year and investigations are done (include details of both individuals if referring a couple)