For Doctors

Doctors

Fertility Checklist

When a patient seeks advice for fertility problems, it is important to conduct good history-taking to rule out possible causes.

This Includes:

  • Current menstrual history to determine the likelihood of ovulation
  • Medical disorders that affect fertility such as hyper/hypothyroidism, prolactinoma, PCOS, hypothalamic pituitary disease, anorexia, weight loss, Cushing’s syndrome, or premature ovarian failure
  • Factors associated with tubal blockage such as previous history of abdominal operation, PID, STD, endometriosis, adhesions
  • Social history such as smoking, alcohol, drugs
  • Factors that may affect male fertility such as testicular hyperthermia; concurrent illnesses or use of recreational drugs (sulphasalazine, nitrofurantoin, tetracyclins, Cimetidine, ketoconazole, colchicine, allopurino, Alpha-blocker, propanolol, ankylating agent, Cannabis, cocaine, anabolic)
  • Coital history such as frequency of unprotected intercourse
Investigations

Investigations Between Male & Female

Male Female
Rubella, Hep B, HIV, VDRL FSH, LH, E2 (measured on D2-D6)
Semen analysis (taken after 2-3 days of sexual abstinence, repeat after 6 weeks if results are abnormal) Progesterone test (D21)
TSH, prolactin, testosterone (measured if period shortened, prolonged, irregular)
Rubella, Hep B, HIV, VDRL
Pap Smear
Ultrasound (PCOS, fibroid)
Tubal patency test
First Line

First Line Of Treatment

firstline icon-21

Pre-existing medical problem

  • Stabilize medical condition
  • Optimize drug usage
  • Refer to Obstetricians

firstline icon-20

Smoking

  • Advise both partners to stop smoking

firstline icon-18

Virology

  • Screen for Rubella immunity
  • Screen for HIV, Hep B, Hep C in high risk group

firstline icon-16

Factors affecting fertility

  • Discuss any factors that warrant early referral

firstline icon-22

Weight

  • Check BMI
  • Advice weight gain if BMI <20
  • Advice weight loss if BMI >30

firstline icon-19

Folic acid

  • Should take 0.4mg daily
  • Advice 5mg daily if there is a history of NTD or epilepsy

firstline icon-17

Timing of intercourse

  • Check couple’s understanding of ovulatory cycle and fertile date
  • Advise on regular intercourse (2-3 times a week)

Factors

Factors That Warrant Referral

Female Male
Age > 35 Testicular maldescent/orchidopexy
Previous ectopic pregnancy Chemo/radiotherapy
Known tubal disease/PID/STD Previous urogenital surgery
Previous tubal/pelvic surgery History of STD
Amenorrhea/Oligomenorrhea Varicocele
Presence of big fibroids