Investigation of infertility
Initial consultation
Male
History
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episodes of testicular pain / swelling
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infection
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trauma
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testicular or groin injury
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underwear
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tobacco, alcohol, cannabis
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chemotherapy
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orgasm problems
Examination
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abdominal
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external genitalia
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hypospadias
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testicular size
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vas deferens
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inguinal hernias
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varicocele
Investigation
Treatment
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surgical reconstruction of blocked vas
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Intrauterine insemination
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In vitro fertilisation
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Intracytoplasmic sperm injection (ICSI)
Female
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contraception
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incidence of separation
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frequency of coitus
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dyspareunia
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menstrual history / cycle
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features of polycystic ovary disease
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irregular periods
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hirsutism
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acne
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features of hyperprolactinaemia
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thyroid dysfunction
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pelvic inflammatory disease
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general medical history
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past gynae history
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previous miscarriage
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sexual history
Examination
Investigation
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rubella immunity
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FSH - raised >35 or not ovulating
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LF, prolactin
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oestrogen
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(TFTs)
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day 21 progesterone (or 7/7 before menstruation)
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serial scanning
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hysterosalpingogram
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laparoscopy
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hysteroscopy
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falloscopy
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cervical factors
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post-coital test
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in-vitro mucus penetration test
Treatment
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Endometriosis
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Ovulation induction
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clomiphene
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gonadotrophins
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Assisted conception
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Tubal surgery
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