1. Laura Neale

2.  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.  Think in terms of cause Anovulatory Male factor Unexplained Tubal Other

4.  Day 2-5 FSH and LH  Day 21 progesterone  Semen analysis  Rubella screen  Chlamydia screen

5.  If anovulatory ◦ TFTs ◦ Prolactin ◦ Oestradiol ◦ Testosterone ◦ SHBG  Assess tubal status (unless semen analysis abnormal)

6.  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)