Clinical Review Fortnightly review

Investigating and managing infertility in general practice

BMJ 1998; 316 doi: http://dx.doi.org/10.1136/bmj.316.7142.1438 (Published 09 May 1998) Cite this as: BMJ 1998;316:1438
  1. T B Hargreave, consultant urological surgeona,
  2. J A Mills, consultant gynaecologistb
  1. a Department of Urology, Western General Hospital, Edinburgh EH4 2XU
  2. b Ninewells Hospital and Medical School, Dundee DD1 9SY
  1. Correspondence to: Mr Hargreave

    The introduction of techniques for treating infertility have given real hope to those who have been unable to have children. It is therefore prudent to review our management of these patients, to be aware of the likelihood of success and to carry out only those investigations and treatments that are likely to be of benefit.

    Summary points

    Investigation of infertility should include both partners, and ideally the same general practitioner should be involved with each partner

    It is good practice to consider the welfare of the future child as well as the needs of the couple

    Duration of infertility and age of female partner are the most important factors when making a prognosis for treatment

    Early referral for specialist assessment is indicated if there is a specific problem or when the female partner is aged over 35 years

    Semen analysis should be carried out in all cases, and if the result is abnormal it should be repeated

    General advice should be given to all couples on, for example, folic acid supplements, rubella immunity, and stopping smoking

    Methods

    For this review, we made extensive use of background material from a major consultation process commissioned by the European Society for Human Reproduction, in which TBH was involved,1 and also used the review of effective health care itself.1 We have both worked for more than 10 years in the field, and we used our experience to include those aspects of infertility practice relevant to general practitioners and primary care physicians.

    When to refer for specialist assessment

    If a couple have not conceived within three years of stopping contraception then the chance of a spontaneous (treatment independent) pregnancy in the next year is not more than 25% irrespective of the results of semen analysis (table 1), and it is therefore appropriate to refer them to a specialist clinic. If the female …

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