Infertility management

Infertility

Infertility is a condition of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.

A detailed history taking and physical examination are invaluable in identifying the causes of infertility.

Investigations

Not every fertility test will be done for every case.

Women

Perform the following as indicated:

• Basic gynaecological examination

• VDRL test

• Urine routine and microscopy

• Cervical mucus examination

• Abdominal pelvic ultrasound / Transvaginal ultrasound

• HSG (Hysterosalpingogram) for assessment of tubal patency

• Hysteroscopy

• Diagnostic laparoscopy

  • This test is only done when symptoms suggest possible endometriosis, as part of treatment for blocked fallopian tubes, or in some cases of unexplained infertility.

• Hormonal profile:

  • FSH

  • LH

  • TSH

  • AMH

  • T3 and T4

  • Testosterone

  • Prolactin

  • Estradiol

  • Progesterone

Men

Perform the following:

• Semen analysis

• VDRL test

• Hormonal profile:

  • FSH

  • Testosterone

  • In selected cases:

    • LH

    • Estradiol

    • Prolactin

Treatment

Treatment depends on the underlying cause.

Non-Pharmacological Treatment of infetility

• Weight reduction in obese clients

• Educate the couple on the importance of having sexual intercourse during the fertile window

• Advise avoidance of smoking and excessive alcohol consumption

Pharmacological Treatment of infetility

Ovulation Stimulation

Clomiphene Citrate

• 50 mg PO once daily for 5 days

• Start between the 2nd and 5th day of menstruation

• Maximum: 6 treatment cycles

Polycystic Ovarian Syndrome (PCOS)

Metformin

• 500 mg PO every 8 hours

• Used alone or in combination with fertility drugs

Hyperprolactinemia

Bromocriptine

• 2.5–5 mg PO once daily

• Continue until prolactin levels return to the normal range

OR

Cabergoline

• Initial dose: 0.25–0.5 mg PO once or twice weekly

• Increase dose gradually every month until prolactin levels normalize

• Doses below 3 mg per week are usually sufficient

Surgical Treatment

• Tubal surgery for tubal blockage

• Myomectomy for uterine fibroids

• Ovarian drilling for PCOS-related infertility

Referral

• Refer all patients with infertility to a gynaecologist.