1. Infertility

2. History See together Full medical history Family history useful in women Rarely indicates cause

3. Women Contraception Previous pregnancies Medical history Pelvic infections crohn’s disaese Surgical history Ovarain cyst, appendicectomy

4. Women Gynae history Cervical smear, cone biopsy PCO Hirsutism Menstrual regularity Menorrhagia Dysmenorrhoea

5. Women Galactorrhoea Imb/pcb Preovulatory mucous recognition Coital frequency/timing

6. Women Current illnesses Drugs – prescribed/recreational Social – diet, smoking, alcohol

7. Men Occupation Xs heat Toxins- cellulose thinners Medical history Mumps VD Surgiacl history Orchidopexy, hernia repair

8. Men Current illnesses Drugs – sulphasalazine Drug misuse- anabolic steroids Smoking, alcohol, caffeine Erectile dysfunction

9. Investigations General Rubella serolgy Fbc, Hep B,C Hiv

10. Investigations Sperm dysfunction Semen analysis Postcoital test

11. Investigations Ovulatory disorder Fsh - day 2-5 Lh – day 2-5 Testosterone Progesterone- 5-10 days before ovulation SHBG Tsh Prolactin

12. Investigations Fallopian tube damage Chlamydia serology >1:256 US contrast salpingography Hysterosalpingogram Laparoscopy and dye

13. Diagnostic tests Over the counter fertility tests Personna Value unclear

14. Management Sperm dysfunction Early referral for ivf - icsi

15. Management Polycystic ovaries Clomiphene days 2-6 Block oestrogen receptors Increased FSH and LH Stimulates follicular development Max use 12 months Metformin

16. Management Raised prolactin Drug related Specialist referral Bromocriptine Cabergoline

17. Management Endometriosis Medical treatment unhelpful IVF

18. Management Fallopian tube damage Antibiotics Early referral

19. Women Age > 38 Infertilty > 3 years Chlamydia antibody titre > 1:256 FSH conc. >10 iu/l LH conc. > 10 iu/l

20. Early referral Men Abnormal seminal fluid analysis Sperm count < 20x10 6 Sperm motility < 50% < 25% progressively motile Sperm appearance < 15% normal