35+ → suggest referral after 6 mon. of trying

The only ‘fertility check’ is trying to conceive

Initial Investigation

• Semen analysis
  • Abnormal: BW, other sperm test, refer to urology, genetic testing
• Ovarian Reserves
• Sonohysterography
• Routine STI Screening
  • Viral blood work if receiving Tm: HIV, HBV, HCV, Syphillis

Male causes (35%)

Etiology

• Abnormal production: Hypogonadism (primary and secondary)
  • Non-obstructive Azoospermia
• Obstruction
• Idiopathic

Treatments

• IUI (specific for male)
• Sperm Extraction, microTESE
• IVF, ICSI
• Donor Sperm
• Sperm quality → takes 2-3 month to improve
  • Smoking affect the quality of sperm
  • DNA fragmentation
    • Substance Use
    • High BMI
    • Varicocele

Female causes

Etiology

• Tubal/Peritoneal (Top, 35%)
• Ovulation Disorder (15%)
• Unexplained (10%)
• Cervical/ Uterine/Other

Specific Tests

• Ovarian Reserves
• Ovulation Test
• Uterine and Tubal Cavity Test
• Viral blood work if receiving Tm: HIV, HBV, HCV, Syphillis, rubella and varicella immunity (female)

Treatments

2. Surgery
3. IVF | | Unexplained (10%) | 1. ‣
4. IVF, ICSI |

Approach