Treatment Guideline Chart

Infertility is the failure to achieve pregnancy after a year of unprotected regular intercourse or therapeutic donor insemination in women <35 years old or within 6 months in women >35 years old.

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 the patient's management for polycystic ovarian syndrome which aims to achieve development of a single follicle and subsequent ovulation in a woman with anovulation.

Infertility Patient Education

Patient Education

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 kg/m2 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
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