Infertility Case Management

 

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A 36yo lady in a 5 year relationship with 18 months of primary infertility presents with her partner for management. She has mild dysmenorrhoea and her cycles vary in length 27-39 days. She is unsure of signs of ovulation. Her past history includes an appendicectomy. Her husband has an unremarkable past hsitory but smokes 10 per day. Her BMI is 29

Mangement strategies for GPs when seeing a couple with infertility.



Female History
Usual gynae Hx with particular attention to
• How long the couple have not been using contraception
• Any previous pregnancies & who the father of these was. The outcomes of the pregnancies. How long each took to achieve
• Sexual history- any issues with intercourse



Male history
Record the male partners name & date of birth in the female partner’s chart.
• Full medical, surgical, drug & social drug Hx
• Any previous pregnancies



Advice
• Advise to take folate +/- iodine
• Stop smoking both partners
• Normalise body weight.
• Up to date pap smears, booster vaccinations, etc



Investigations
1. Female blood tests done 7 days before onset of expected next menses or randomly if patient oligo/amenorrhoiec
i. Progesterone, LH, estradiol, TSH
ii. Rubella & varicella IgG
iii. Vitamin D
iv. Antichlamydial antibody testing
v. FBC, BGA



2. Female bloods if oligo/amenorrhoiec add as extras
i. Prolactin
ii. SHBG, testosterone, FAI
iii. HBA1C, fasting insulin & fasting glucose
iv. DHEA, 17OH progesterone & androstenedione if hirsute



3. Pelvic ultrasound Newcastle Ultrasound for women Lingard on day 1-5 cycle. Please call with 1st day of period. Explain it will be transvaginal.



4. Semen analysis Genea Newcastle Lingard, Merewether or Hunter IVF. Must call to make an appointment ahead of time (can’t just rock up). Give patient yellow topped jar & ask them to get it to clinic within 1 hour of production at their allotted time. 2-7 days abstinence recommended. Keep jar at body temperature by putting in pocket against skin.  They can also use the men’s room at the clinic if they prefer or live >1hour from Merewether clinic. General pathology companies are not able to perform sperm counts reliably.



Review
See fertility specialist to discuss results & to consider tubal patency testing.