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Infertility

Definition:

Failure to conceive after regular unprotected sexual intercourse for 1 year in the absence of known reproductive pathology.

 

Refer to the Infertility Clinic:

Refer both partners where they have infertility as defined above

Offer an earlier referral for specialist consultation to discuss the options for attempting conception, further assessment and appropriate treatment, even if the couple would not be eligible for NHS funded assisted conception (eg previous children, age 40-45), where:

·       the woman is aged 36 years or over

·       there is a known clinical cause of infertility or a history of predisposing factors for infertility (see below), or investigations are abnormal

 

Women over the age of 44 seeking conception should be referred privately and advised that the only effective treatment is likely to be from using donor eggs

BMI >35 is not an exclusion for referral to the fertility clinic, although women with a BMI >=35 will usually be asked to lose weight to bring their BMI below 35 prior to receiving fertility treatment.

Patients should be advised if they require assisted conception (e.g. SO/IUI or IVF) then NHS funding is restricted and only available if they meet the criteria set out in NHS Kernow’s policy. (SO=Super Ovulation; IUI= intrauterine insemination)

 

Investigations:

·         Semen analysis, if abnormal repeat after 3 months, however if gross spermatozoa deficiency (azoospermia or severe oligozoospermia) has been detected the repeat test should be undertaken as soon as possible

·         Mid luteal serum progesterone (taken 7 days prior to expected onset of menstruation, eg day 19 of a 26 day cycle); repeat in subsequent cycle if <28nmol/l.

·         Rubella serology (if not immune, vaccinate and advise contraception for one month)

·         Chlamydia serology (if raised treat both male and female eg azithromycin 1g STAT)

 

Predisposing factors:

·         Amenorrhoea/oligomenorrhoea

·         PMH: Pelvic inflammatory disease

·         Undescended testes

·         Previous treatment for cancer

·         Either partner HIV/Hepatitis positive.

Pre-referral advice:

·         Aim for BMI <29 in both partners

·         Take folic acid

·         Smoking cessation

·         Sexual intercourse every 2-3 days not timed to any part of the cycle

·         Restrict alcohol to <2U /wk females and <4 U /wk males

 

Notes:

Female same-sex couples will always have to pay for the semen and if no obvious fertility problem they may wish to go to Fertility Exeter or to SWCRM Derriford for private treatment.   They can be referred to CCRM if they have predisposing factors or failed conception after self-funded insemination

Link to NHS Assisted Conception Funding Policy: http://www.kernowccg.nhs.uk/media/97221/assistedconceptionpolicy.pdf

NHS funding criteria for assisted conception: http://rms.kernowccg.nhs.uk/content/files/NHS%20funding%20Criteria%20for%20assisted%20Conception.doc