Feature Article

The subfertile couple: a guide to investigations

Kharis Burns, Howard Smith



A delay in identifying and treating many subfertile couples is associated with poorer outcomes because of a reproductive decline with increasing female age and prolongation of the associated psychological stress. Early investigation of both partners in general practice is therefore important to expedite the diagnosis and facilitate specialist review for tailored treatment.

Key Points

  • One in six couples may have difficulty achieving a pregnancy after 12 months.
  • Multiple male and female factors influence a couple’s chance of a successful pregnancy. A thorough history from both partners focusing on lifestyle factors, including alcohol intake, extremes of weight (underweight or obesity), diet, exercise and use of certain medications, are key in the initial workup.
  • Increasing female age is a common cause of decreased fertility.
  • Targeted investigation of infertile couples can be commenced in the primary care setting.
  • Early involvement of a fertility specialist should be arranged for women over 35 years of age and those with oligomenorrhoea or amenorrhoea, recurrent miscarriage, an abnormal pelvic scan, a history of pelvic surgery or previous pelvic infection.

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