This guideline from NICE, doesn’t really alter management for us. It outlines initial advice that should be given to couples and a lot of detail about various treatment methods, which may be helpful if you have a specific query. One important aspect is raising the age limit for IVF up to 42. So though this isn’t new, a quick reminder of what we should be doing.
When to investigate:
80% of couples will conceive within a year and 90% within 2 yrs. Therefore you wouldn’t normally investigate within 1 year, unless the woman is 36 or older, or there are known fertility problems or factors which could impact upon fertility.
General advice to give couples trying to conceive:
- Sex – have sex every 2 to 3 days
- Alcohol – 1 to 2 units once or twice a week for women and avoiding intoxication. For men, excessive alcohol intake can affect fertility.
- Smoking – reduces female fertility and reduces sperm quality in men (though with uncertain impact on fertility).
- BMI – aim for BMI 19 to 30. Men with BMI over 30 are likely to have reduced fertility. Women who join a group giving advice on diet and exercise are more likely to conceive.
- Folic Acid – should be advised
- Occupation – some occupations could cause problems, so ask what they do (NICE doesn’t advice what occupations could cause problems)
- OTC medications – can cause problems, so ask what they take.
- HIV / Hep B and C – are these conditions optimised? Refer on if not for advice.
- Sperm Count – if there are abnormalities, a further sample should be done 3 months later (unless there is a significant abnormality, in which case it should be done as soon as possible).
- D21 Progesterone (if 28d cycle) – to check they are ovulating. If their cycle is prolonged, do it 7d before their period is due and then weekly until they get their period.
- FSH / LH – if irregular menstrual cycle
- Rubella status and then vaccinate (shouldn’t fall pregnant within 1m).
- Cervical screening – if due
- Chlamydia (if undergoing instrumentation)
DO NOT do – basal temperature measurement, PRL (unless specific indication), TFT).