Infertility

Infertility: causes and initial investigations


Infertility affects around 1 in 7 couples. Around 84% of couples who have regular sex will conceive within 1 year, and 92% within 2 years

Causes

  • male factor 30%

  • unexplained 20%

  • ovulation failure 20%

  • tubal damage 15%

  • other causes 15%


Basic investigations

  • semen analysis

  • serum progesterone 7 days prior to expected next period. For a typical 28 day cycle, this is done on day 21.


Interpretation of serum progestogen


Level

Interpretation

< 16 nmol/l

Repeat, if consistently low refer to specialist

16 - 30 nmol/l

Repeat

> 30 nmol/l

Indicates ovulation


Key counselling points

  • folic acid

  • aim for BMI 20-25

  • advise regular sexual intercourse every 2 to 3 days

  • smoking/drinking advice