• 20-25% chance of healthy couple of reproductive age becoming pregnant each reproductive cycle

• 6-% within 6mo

• 84% first year

• 92% second year

• address lifestyle

  • BMI\<18, >30

  • smoking

  • EtOH

• Investigation

  • 12mo \<35yo

  • 6mo >35yo

  • both partners

• Female with regular mestrual cycels

  • presume ovulation occuring

  • progesterone

    • 7d prior to expected date of menstruation to test if ovulation occurred

      • if >25 then likley

  • FSH, LH and oestradiol checked early in menstural cycles

    • d2-6

    • elevated FSH suggests reduced ovarian reserve

• Male

  • semen

    • if abnormal repeat 6wk

Public funding

• BMI 18-32

• Non smoker or ex-smoker for >3mo

• Age \<40

• Less than 2 children from current relationships

• at least 2 years subfertility

• or

• 1 year if age \<35 or 6mo if age >35 with

  • anovulation

  • azoospermia

  • oligospermia

  • bilateral salingectomy

  • tubal obstruction

  • oophrectomy

  • premature ovarian failure

early referral

• female >35

• female amenorrhoea/oligomenorrhoea

• female partner history of abdominal/pelvic surgery

• female partner abnormal pelvic exam

• femal/male history of STI

• male abnormal semen

• male undescended testes or other genital pathology

• varicocele

• urogenital surgery

• couple are very concerned and likely to benefit from reassurance