-Definition: Infertility is defined as the inability to conceive after one year of regular unprotected intercourse.
-Will approach infertility as a problem that affects couples instead of individuals and do H&P for both partners.
-See HPI.
-PE: Normal genital exam is normal. Normal testes size/consistency. No varicocele, no hypospadias.
–Causes of infertility reviewed with the patient.
-Will work up both males & females since combined factors are responsible for 40% of the cases.
Initial lab/studies (Male): Semen analysis after 72 hours of abstinence. If done < 72 h may result in a low sperm count. If > 72 h, may result in decreased sperm motility. “Because sperm generation time is just over two months, it is recommended to wait three months before repeat sampling,” if needed.
-Basic labs: CBC, CMP, lipid panel, etc.
-Will check for STIs.
Counseling:
-Lifestyle modification: Keep BMI between 20 and 25. Avoid smoking and illicit drug use and limit alcohol consumption to 4 or fewer drinks per week since these negatively impact fertility in both males and females. Recommend moderate exercise and decreasing stress and limit caffeine intake to less than 250 mg/day.
-Recommend intercourse every other day during the most fertile period which is the six days preceding ovulation and the day after ovulation.
-Approximately 85–90% of healthy young couples conceive within 1 year, most within 6 months. Infertility, therefore, affects approximately 10–15% of couples. Patient informed that 50% of couples who have not conceived in the first year of trying will conceive in the second year. “Couples with unexplained infertility may want to consider another year of intercourse before moving to more costly and invasive therapies, such as assisted reproductive technology.”AAFP
-Will refer the couple to formal counseling because anxiety over infertility may cause increased stress and decreased libido, further compounding the problem.