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Infertility Management and Referral

Infertility Management and Referral. Laura Neale. History and Examination. Unprotected sex 1 year (unless known problems) Primary or secondary Predisposing factors Menstrual cycle STIs Previous ectopics Galactorrhoea/hirsutism/acne Systemic diseases

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Infertility Management and Referral

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  1. Infertility Management and Referral Laura Neale

  2. History and Examination • Unprotected sex 1 year (unless known problems) • Primary or secondary • Predisposing factors • Menstrual cycle • STIs • Previous ectopics • Galactorrhoea/hirsutism/acne • Systemic diseases • Drug history (NSAIDs, chemotherapy, neuroleptics) • Lifestyle factors • BMI • Features of PCOS

  3. Investigations (1) • Think in terms of cause Anovulatory Male factor Unexplained Tubal Other

  4. Investigations (2) • Day 2-5 FSH and LH • Day 21 progesterone • Semen analysis • Rubella screen • Chlamydia screen

  5. Investigations (3) • If anovulatory • TFTs • Prolactin • Oestradiol • Testosterone • SHBG • Assess tubal status (unless semen analysis abnormal)

  6. Counselling • Optimise weight • Usual lifestyle advise • Folic acid • Investigative course • Costs (emotional and financial) • Chances failure (i.e. only 15% success rate per IVF cycle if age > 36)

  7. Any Questions?

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