Infertility is when a couple of reproductive age is unable to conceive after a year or more of regular unprotected intercourse.

It can be primary if no pregnancy has ever occurred or secondary if pregnancy has occurred irrespective of the outcome.

Ovulation induction is part of patient's management which aims to achieve development of a single follicle & subsequent ovulation in woman w/ anovulation.

Patient Education

General Advice to the Couple

Couple Education

  • Inform couples that vaginal sexual intercourse every 2-3 days is the optimal frequency to result in pregnancy
  • Inform couples that both female and, to a lesser extent, male fertility decrease with age
  • Emotional support should be provided to the couple because infertility oftentimes produces stress and stress adds to their fertility problems because of decreased sex drive and frequency of intercourse
    • Encourage the couple to join groups and have counseling
  • Waiting to have intercourse during ovulation is generally not recommended because it can cause undue stress
  • If couples find it difficult to have frequent sexual intercourse, LH ovulation kits may be useful for prediction of ovulation

Lifestyle Modification

Smoking Cessation

  • There is significant association between decreased fertility and women who smoke
    • Women who smoke should be made aware that smoking can reduce fertility and should be assisted in smoking cessation
    • Infertility problems associated with smoking may not be surpassed by assisted reproductive technologies
  • There is also an association between men who smoke and semen parameters but the effects on fertility are unknown
  • Passive smoke may also affect the chances of conceiving

Moderation of Alcohol Intake

  • Women who are trying to conceive should be counseled to stop or limit alcohol intake to 1-2 units of alcohol 1-2x per week to reduce the risk of harming a developing fetus
  • Excessive alcohol intake in men, eg >3-4 units per day, can be detrimental to the semen quality

Preconceptional Advice

  • Vaccinations (eg hepatitis B, rubella) are best completed before starting any infertility treatment because some vaccines should not be administered during pregnancy
  • Rubella status should be checked
  • Advise on the use of Folic acid 0.4 mg daily while attempting conception
  • Routinely screen for occupational hazards, use of prescribed, over-the-counter and recreational drugs, and complementary therapy in couples seeking infertility treatment and appropriate advice should be given
  • A specialist referral may be needed if woman is >36 years old, there is a positive history of predisposing factors to infertility or known cause of infertility, or a planned treatment that may lead to infertility, eg cancer treatment

Maintain BMI of 19-29 kg/m2

  • Women with BMI ≥30 kg/m2 may take longer to conceive
  • Women with BMI ≥30 kg/m2 and who are not ovulating should be made aware that if they lose weight, they may increase their chance of conception
    • Women with BMI <19 with irregular menses or are not menstruating should also be made aware that if they gain weight, their chance of conception may improve
  • Men with BMI ≥30 kg/m2 may have a decreased fertility

Lifestyle Modifications in Women with Hypogonadotropic Hypogonadism and/or Weight-Related Amenorrhea

  • Lifestyle modification should be the initial treatment and must be tailored to individual patient
  • Women with BMI <19 kg/m2 and who have irregular menstrual cycles or are not menstruating should be informed that increasing BMI will likely improve their chance of conception
  • Stress management and reduction of exercise to moderate level may assist in the spontaneous recovery of menstrual function
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Endocrinology - Malaysia digital copy today!
Editor's Recommendations
Most Read Articles
25 Aug 2015
At the Northern Pharmacists Convention cum 48th Malaysian Pharmaceutical Society Seminar 2015 held recently at Bayview Beach Hotel, Penang, Sanofi invited three distinguished speakers – Dr Khaw Chong Hui, Dr Lo Kang Shang Chit, and Professor Dr Karl-Josef Gundermann – to speak on the importance of renal protection in managing diabetic hypertension, the use of antihistamines in managing chronic urticaria (CU), and the role of essential phospholipids (EPL) in fatty liver diseases, respectively.
Roshini Claire Anthony, 07 Nov 2017

Women who are underweight, particularly in their late teens and mid-thirties, may be at risk for early menopause, a recent study found. 

16 Aug 2014

New drug applications approved by US FDA as of 15-30 Aug which includes New Molecular Entities (NMEs) and new biologics. It does not include Tentative Approvals. Supplemental approvals may have occurred since the original approval date.

Audrey Abella, 20 Jan 2017
Diabetes was not a risk factor for total knee replacement (TKR) due to severe knee osteoarthritis, a Singapore study found.