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

Causes

• male factor 30%
• unexplained 20%
• ovulation failure 20%
• tubal damage 15%
• other causes 15%

Basic investigations

• A healthy couple can expect to take up to one year to conceive. Investigations are therefore usually performed after one year of regular attempts to conceive. It may however be prudent to address any mechanical reasons that are preventing the couple from conceiving, hence the sexual intercourse history.
• semen analysis
• serum progesterone 7 days prior to expected next period. For a typical 28 day cycle, this is done on day 21.

Key counselling points

• folic acid
• aim for BMI 20-25
• advise regular sexual intercourse every 2 to 3 days
• smoking/drinking advice