Infertility Management and

Referral

Laura Neale

Unprotected sex 1 year (unless known problems) Primary or secondary Predisposing factors

◦ Menstrual cycle◦ STIs◦ Previous ectopics◦ Galactorrhoea/hirsutism/acne◦ Systemic diseases◦ Drug history (NSAIDs, chemotherapy, neuroleptics)

Lifestyle factors

BMI Features of PCOS

History and Examination

Think in terms of cause

AnovulatoryMale factorUnexplainedTubalOther

Investigations (1)

Day 2-5 FSH and LH Day 21 progesterone

Semen analysis Rubella screen Chlamydia screen

Investigations (2)

If anovulatory◦ TFTs◦ Prolactin◦ Oestradiol◦ Testosterone◦ SHBG

Assess tubal status (unless semen analysis abnormal)

Investigations (3)

Optimise weight Usual lifestyle advise Folic acid Investigative course Costs (emotional and financial) Chances failure (i.e. only 15% success rate

per IVF cycle if age > 36)

Counselling

Any Questions?