NICE guideline, CG156
- the woman is aged under 40 years
- they do not use contraception and have regular sexual intercourse.
- Every 2 to 3 days optimises the chance of pregnancy
- Women who have BMI of over 30 should be informed that they are likely to take longer to conceive and will affect treatment success rates.
- Women with BMI less than 19 and irregular menstruation should be counselled to gain weight.
- Strong association between smoking and fertility in both partners.
- Affects success rates of ARTs.
- No evidence on effect of caffeine on fertility.
- Female patients should be informed that 1 or 2 units of alcohol once or twice per week reduces risk of harming a developing fetus.
- Intoxication may affect semen quality.
- There is an association between elevated scrotal temperature and reduced semen quality
Mental history Personal history
- pH: 7.2 or more
- sperm concentration: 15 million spermatozoa per ml or more
- total sperm number: 39 million spermatozoa per ejaculate or more
- total motility: 40% or more motile
or 32% or more with progressive motility
- vitality: 58% or more live spermatozoa
- sperm morphology (percentage of normal forms): 4% or more
2. Serum progesterone in the mid-luteal phase of their cycle (day 21 of a 28-day cycle) even if they have regular menstrual cycles.
3. Serum gonadotrophins (follicle-stimulating hormone and luteinising hormone) on Day2-3 especially in irregular periods
-More important in >35 years old, suspected ovarian failure and to detect response to ovulation induction.
1. Total antral follicle count.
2. Anti-Müllerian hormone of less than or equal to 5.4 pmol/l for a low response and greater than or equal to 25.0 pmol/l for a high response
3. Follicle-stimulating hormone greater than 8.9 IU/l for a low response and less than 4 IU/l for a high response.
1. Hystersalpingography (HSG):
- usually after failed successive cycles of ovulation induction.
- good predictive but requires expertise.
- TVS scan during which air and saline or a solution of D-galactose is infused into the uterine cavity and observed to flow along the fallopian tubes.
- Requires more expertise.
- Less invasive.