Management of infertility in general practice
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Transcript Management of infertility in general practice
Rohan subasinghe
Some facts
Affects 1 in 6
Fertility declines with age
84 % - cumulative prob of pregnancy in 1st yr
92 % - cumulative prob of pregnancy in 2nd yr
Infertility is failure to conceive after regular
unprotected intercourse for 2 yrs in absence of known
reproductive pathology
Initial management
Early investigation in – people with predisposing
factors
Both partners – couple based
Rubella status
Folic acid while trying to concieve (0.4-5 mg)
Explain each stage of investigation
Detalied rug hx, drug abuse, alcohol etc
General advice
Give up smoking
Alcohol - 2 units for women 2-4 units for men
BMI in women– 19-29
Men with poor quality sperm – loose underwear
Regular intercourse throughout cycle
No evidence for temperature charts
Initial investigations
Semen analysis – check twice
Serum progesterone in mid-luteal stage
Serum gonadotrophins
No value in thyroid/prolactin in absence of pathology
and in th presence of a regular cycle
Semen analysis
Abstain for 3 days
Vol – 2-5ml
Liquefaction tuime – within 30 mins
Concentration - >20 mill/ml
Motility - >50 %
Morphology - >30 %
Wbc - <1 mill/ml
Mid-luteal progesterone
7 days before period in 28 day cycle
Timing crucial
Adjust for longer periods
<16 nmol/l –repeat – refer if consistently low
>16 but <30 – repeat - if same or lower – refer
>30 – proof of ovulation
Flow chart - RCOG
http://www.gp-
training.net/protocol/gynaecology/infert2.htm
Fertility algorithm - NICE
http://www.rcog.org.uk/resources/public/pdf/fertility
_algorithm.pdf