Clinical Review ABC of subfertility

Making a diagnosis

BMJ 2003; 327 doi: (Published 28 August 2003) Cite this as: BMJ 2003;327:494
  1. Alison Taylor


    Couples present at a surgery or clinic because they have not conceived as quickly as they had expected. Some are concerned there may be serious problem that will stop them having a family. Subfertility investigations determine whether a problem exists and enable a rational discussion about options for treatment. The treatment may include waiting for a spontaneous conception. Some of the distress associated with subfertility may be reduced by a prompt and systematic protocol of investigations that allows couples to move quickly to the most appropriate treatment.

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    Couple consulting doctor

    Investigations: who and when

    Subfertility is defined as failure to conceive after one year of unprotected regular sexual intercourse. Although usually it would be reasonable to start investigations after this time, earlier investigations and referral may be justified where there are important factors in either partner's history.,

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    Factors that may warrant early referral or investigation*

    A woman's age is one of the main factors affecting her chance of conception. The chances of most treatments being successful are reduced substantially after a woman reaches 35 years and become negligible by her mid-40s. Hence, if couples are to gain the maximum benefit from the most appropriate treatment, investigations should be started promptly (after six months of trying if the woman is over 35) and completed according to a locally agreed protocol between general practitioners and hospital providers. Couples can then be counselled about the implications of test results, and a management plan agreed that takes into account the test results and the couple's beliefs and wishes.

    At initial presentation both partners should have a history taken and be examined. Regular intercourse two to three times a week should be advised, but basal body temperature charts are not helpful and should be avoided.

    The female partner of couples presenting with subfertility should have their rubella status checked …

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