Assessing Patient Fertility: Guide for Primary Caregivers & When to Refer to a Fertility Specialist

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Assessing Patient Fertility

Assessing Patient Fertility - A Guide for Primary Caregivers and When to Refer to a Fertility Specialist

Patients will turn to their primary caregiver with questions about fertility and their reproductive options. This brochure is designed to help you with proper diagnosis and treatment options.

Click here to access a PDF version of this valuable information

Basic Investigation
The optimal timing for intercourse is 2 to 3 times per week around mid-cycle. This is approximately 12 to 16 days prior to the next menstruation.

If timing and frequency is adequate:
	Provide positive feedback and encourage continued efforts

Additional advice should be provided to the patient if:
	There is infrequent intercourse
	There is improper timing
	Avoid use of contaminants such as lubricants or douches
	Potential sexual dysfunction

Tools to help patient monitor their cycle:
	Menstrual Calendar
	Basal Body Temperature (BBT)
	Ovulation Predictor Kits

If Patient Has A Regular Cycle
If patient has a regular cycle, provide reassurance and confirm proper timing of intercourse.
If Patient is > 35 years old, measure Day 2-4 FSH. If FHS is > 10 MIU, early referral to fertility specialist is recommended.
It is advisable to discourage long-term use of ovulation predictor kits or BBT charts as it maybe shielding the patient from other issues. Other suggestions and guidance include:
	Intercourse should precede temperature elevation in future cycles
	Average several months to estimate the most fertile time in future cycles
	Time of ovulation may be variable. If unclear try counting 14 days back from next menses

If more confirmation is needed, a Progesterone test should be ordered approximately 7 days post-ovulation or 7 days pre-menses.

If Patient Has an Irregular Cycle
	Review FSH (preferable days 2-4) to rule out early menopause
	Test TSH and prolactin
	Refer to a fertility specialist

If more confirmation is needed, a Progesterone test should be ordered approximately 7 days post-ovulation or 7 days pre-menses.

Tubal Patency

If patient has a history of pelvic pain, infection, known endometriosis, prior ectopic pregnancy or abnormal physical findings then early referral to a fertility specialist is advisable.

If there is no history of physical findings suggesting tubal or peritoneal disease; no abnormality in ovulation, sperm count, or sexual function; then after one year of trying the patient should be referred to a fertility specialist for a tubal patency test. This should be arranged sooner if patient is > 35 years.

Male Factor - Semen Analysis
A semen analysis should be performed to asses if there is male factor in a couples infertility. It is advisable to use a lab that specializes in semen analyses such as ReproMed. ReproMed has a certified Andrologist onsite and undergoes external quality control testing and verification.
	Refer male patient to specialized lab for basic semen analysis
	If report indicated an abnormal semen analysis, refer couple to a fertility clinic

Even though the report may be normal, the couple’s inability to conceive may still be related to male factor. A more comprehensive semen analysis maybe required. These tests include: sperm antibodies, sperm function, and DNA integrity. A full analysis can be obtained at a specialized lab.

When to Investigate Fertility Issues
	All patients (male and female) regardless of age if they have been trying for a year
	After completing basic investigation (assess ovulation, sexual function, semen analysis)
	Anxious patients
	Risk factors present or patient is > 35 years of age

Referring to a Fertility Specialist
If there is no obvious abnormality, other than age, it is best to refer to a fertility specialist:
	Age < 35 within 12 months of trying to conceive
	Age 36—39 within 6—12 months of trying to conceive
	Age > 40 within 6 months of trying to conceive

If there is a risk factor from patients medical history or from a physical exam, patient should be referred immediately.
Other key areas to consider referral to fertility specialist:
	Woman’s age > 38 years
	Unexplained infertility > 2 years
	Day 3 FSH > 10 MIU
	Not tubes or inoperable tubal disease
	Known endometriosis
	Failed clomiphene treatment
	Male factor

Fertility That Increase Risk of Infertility
For Women:
	> 35 years of age for women
	Family history of menopause < 45 years of age
	Prior treatment for cancer
	History of STD or pelvic inflammatory disease
	Previous abdominal /pelvis surgery

For Men:
	> 40 years of age
	Un-descended Testes
	Prior treatment for cancer
	Previous urogential surgery

At ReproMed, you can have confidence in your care. For more than 20 years we have been servicing patients in the field of Reproductive Medicine. Under the leadership of our Medical Director, Dr. Alfonso P. Del Valle MD, FRCS(C), we have been at the forefront of reproductive sciences. We are proud of our high pregnancy rates and internationally renowned research achievements. We strive to provide compassionate, efficacious, and safe care for individuals trying to build families.


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