Infertility affects around 1 in 7 couples. Around 84% of couples who have regular sex will conceive within 1 year, and 92% within 2 years.
For women under 35 years old, investigations should begin after 12 months of regular intercourse. For women over 35, investigations can start after 6 months. Regular sexual intercourse means having intercourse every 2–3 days.
Early referral should be considered when:
| Female | Male |
|---|---|
| Age above 35 | Previous surgery on genitalia |
| Amenorrhoea | Previous STI |
| Previous pelvic surgery | Varicocele |
| Previous STI | Significant systemic illness |
| Abnormal genital examination | Abnormal genital examination |
Causes
Basic investigations
(LH) measurement is used to predict, not confirm, ovulation. A surge in LH levels triggers the final maturation and rupture of the ovarian follicle, leading to ovulation approximately 24-36 hours later. Urine ovulation predictor kits work by detecting this LH surge.
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Day 21 progesterone test is the most reliable test to confirm ovulation
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