Doctors
Fertility Checklist
When a patient seeks advice for fertility problems, it is important to conduct good history-taking to rule out possible causes.
This Includes:
- Current menstrual history to determine the likelihood of ovulation
- Medical disorders that affect fertility such as hyper/hypothyroidism, prolactinoma, PCOS, hypothalamic pituitary disease, anorexia, weight loss, Cushing’s syndrome, or premature ovarian failure
- Factors associated with tubal blockage such as previous history of abdominal operation, PID, STD, endometriosis, adhesions
- Social history such as smoking, alcohol, drugs
- Factors that may affect male fertility such as testicular hyperthermia; concurrent illnesses or use of recreational drugs (sulphasalazine, nitrofurantoin, tetracyclins, Cimetidine, ketoconazole, colchicine, allopurino, Alpha-blocker, propanolol, ankylating agent, Cannabis, cocaine, anabolic)
- Coital history such as frequency of unprotected intercourse
Investigations
Investigations Between Male & Female
Male | Female |
---|---|
Rubella, Hep B, HIV, VDRL | FSH, LH, E2 (measured on D2-D6) |
Semen analysis (taken after 2-3 days of sexual abstinence, repeat after 6 weeks if results are abnormal) | Progesterone test (D21) |
TSH, prolactin, testosterone (measured if period shortened, prolonged, irregular) | |
Rubella, Hep B, HIV, VDRL | |
Pap Smear | |
Ultrasound (PCOS, fibroid) | |
Tubal patency test |
First Line
First Line Of Treatment
Pre-existing medical problem
- Stabilize medical condition
- Optimize drug usage
- Refer to Obstetricians
Smoking
- Advise both partners to stop smoking
Virology
- Screen for Rubella immunity
- Screen for HIV, Hep B, Hep C in high risk group
Factors affecting fertility
- Discuss any factors that warrant early referral
Weight
- Check BMI
- Advice weight gain if BMI <20
- Advice weight loss if BMI >30
Folic acid
- Should take 0.4mg daily
- Advice 5mg daily if there is a history of NTD or epilepsy
Timing of intercourse
- Check couple’s understanding of ovulatory cycle and fertile date
- Advise on regular intercourse (2-3 times a week)
Factors
Factors That Warrant Referral
Female | Male |
---|---|
Age > 35 | Testicular maldescent/orchidopexy |
Previous ectopic pregnancy | Chemo/radiotherapy |
Known tubal disease/PID/STD | Previous urogenital surgery |
Previous tubal/pelvic surgery | History of STD |
Amenorrhea/Oligomenorrhea | Varicocele |
Presence of big fibroids |