Altmetric

Investigation and management of subfertility

File Description SizeFormat 
190623 Best Pratice Article Changes Accepted Final.pdfAccepted version679.76 kBAdobe PDFView/Open
Title: Investigation and management of subfertility
Authors: Thurston, L
Abbara, A
Dhillo, W
Item Type: Journal Article
Abstract: Subfertility affects one in seven couples and is defined as the inability to conceive after 1 year of regular unprotected intercourse. This article describes the initial clinical evaluation and investigation to guide diagnosis and management. The primary assessment of subfertility is to establish the presence of ovulation, normal uterine cavity and patent fallopian tubes in women, and normal semen parameters in men. Ovulation is supported by a history of regular menstrual cycles (21–35 days) and confirmed by a serum progesterone >30 nmol/L during the luteal phase of the menstrual cycle. Common causes of anovulation include polycystic ovary syndrome (PCOS), hypothalamic amenorrhoea (HA) and premature ovarian insufficiency (POI). Tubal patency is assessed by hysterosalpingography, hystero-contrast sonography, or more invasively by laparoscopy and dye test. The presence of clinical or biochemical hyperandrogenism, serum gonadotrophins (luteinising hormone/follicle stimulating hormone) / oestradiol, pelvic ultrasound to assess ovarian morphology / antral follicle count, can help establish the cause of anovulation. Ovulation can be restored in women with PCOS using letrozole (an aromatase inhibitor), clomifene citrate (an oestrogen antagonist) or exogenous gonadotrophin administration. If available, pulsatile gonadotrophin releasing hormone therapy is the preferred option for restoring ovulation in HA. Spermatogenesis can be induced in men with hypogonadotrophic hypogonadism with exogenous gonadotrophins. Unexplained subfertility can be treated with in vitro fertilisation after 2 years of trying to conceive. Involuntary childlessness is associated with significant psychological morbidity; hence, expert assessment and prompt treatment are necessary to support such couples.
Issue Date: 16-Aug-2019
Date of Acceptance: 25-Jun-2019
URI: http://hdl.handle.net/10044/1/71691
DOI: 10.1136/jclinpath-2018-205579
ISSN: 1472-4146
Publisher: BMJ Publishing Group
Start Page: 579
End Page: 587
Journal / Book Title: Journal of Clinical Pathology
Volume: 72
Issue: 9
Copyright Statement: © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Sponsor/Funder: National Institute for Health Research
Funder's Grant Number: CS-2018-18-ST2-002
Keywords: biochemistry
diagnostics
endocrinology
fertility
laboratory tests
Female
Fertility
Humans
Infertility, Female
Infertility, Male
Male
Ovulation
Predictive Value of Tests
Pregnancy
Reproductive Techniques, Assisted
Risk Factors
Spermatogenesis
Time-to-Pregnancy
Treatment Outcome
Humans
Infertility, Male
Infertility, Female
Treatment Outcome
Reproductive Techniques, Assisted
Risk Factors
Predictive Value of Tests
Spermatogenesis
Fertility
Ovulation
Pregnancy
Female
Male
Time-to-Pregnancy
Pathology
1103 Clinical Sciences
Publication Status: Published
Online Publication Date: 2019-07-11
Appears in Collections:Faculty of Medicine



Unless otherwise indicated, items in Spiral are protected by copyright and are licensed under a Creative Commons Attribution NonCommercial NoDerivatives License.

Creative Commons