Diagnosing infertility

Fertility is a sensitive issue for many couples. Your patients may come to you for advice and help when they are having difficulty conceiving. Since there are many factors that could play a role in successful conception and because it is so important to be able to make an accurate diagnosis of infertility and its causes, we have created a simple fertility assessment chart for your use. For more complex diagnoses, you can refer your clients to our clinic for assessment.

    Initial advice for couples concerned about delays in achieving conception:
  • Cumulative probability of pregnancy in the general population:
    • - 84% in the 1st year
    • - 92% in the 2nd year
  • Age related decline in fertility
  • Lifestyle advice:
    • - Unprotected sexual intercourse at least 3 times a week
    • - ≤ 1–2 units of alcohol / week for women; ≤ 3–4 units / for men
    • - Body Mass index of 19–29
    • - Information about prescribed, over the counter and recreational drugs
    • - Information about hazards
  • Offer pre–conception advice:
    • - Folic acid
    • - Rubella Susceptibility
    • - Cervical Screening
Infertility

Failure of a couple to conceive after 2 years of regular unprotected sexual intercourse in the absence of a known reproductive pathology.

Early investigations if:

History of predisposing factors (such as Amenorrhea, Pelvic Inflammatory Disease or Cryptorchididm)

Woman's age > 35 years

People with Human Immunodeficiency Virus (HIV) infection

Hepatitis C and prior treatment for cancer

Principles of care:

Couple–centred management

Access to evidence based information

Prompt access to appropriate medical care with early diagnosis and referral

Intervention by specialist teams

Psycho–social counselling from someone not directly involved in management of the couples fertility issues

Contact with fertility support groups