Clinical Medicine Reviews in Women's Health

Each GP sees approximately two infertile couples each year. Despite the relative lack of opportunity to rehearse the skills necessary to manage infertile couples a basic understanding will assist in the GPs advocacy role. Broadly the causes can be classified as male factors, ovulatory disorders, tubal disorders or unexplained infertility. The initial investigations commonly performed by GPs include semen analysis, serum mid-luteal progesterone and serum follicle stimulating hormone. The introduction of tubal assessment with open access hysterosalpingography (HSG) has given GPs the opportunity to manage the initial stages of infertility more effectively. Management strategies for the GP include optimising general health, weight loss for obese infertile women, ovulation induction with clomifene and expectant management for young women with no identified cause for their delayed fertility. Referral of couples with semen problems or tubal disorders should be to dedicated specialist fertility units capabe of delivering the treatment necessary, typically in-vitro fertilisation (IVF) or intra-cytoplasmic sperm injection (ICSI) for this cohort. Current guidelines fail to address the impact of a full fertility assessment in primary care and the effect upon subsequent management and referral from primary care. This review focuses on the assessment and management of female infertility from a UK perspective.