N97.9
DESCRIPTION
Inability to conceive after a year of regular sexual intercourse without contraception.
GENERAL MEASURES
Counselling.
Lifestyle modification, e.g. weight optimisation, smoking cessation and regular sexual intercourse.
Investigations
- Partner semen analysis.
- Anti-mullerian hormone (AMH) levels to evaluate ovarian reserve (>1.1 ng/ml suggests good ovarian reserve).
- If AMH is unavailable - Mid-luteal (day 21) progesterone assay: >30 nmol/L suggests adequate ovulation (Specialist indication).
- Laparoscopy and/or hysterosalpingography (Specialist supervision).
MEDICINE TREATMENT
Treat the underlying disease.
For induction of ovulation, in women with confirmed anovulation:
There are two options available: letrozole or clomifene.
Note: Women should be counselled on the risk of multiple births with medicines inducing ovulation.
Letrozole is likely to result in more pregnancies and sooner pregnancies but both agents are effective.
Administer letrozole following a spontaneous menses or a medroxyprogesterone acetate withdrawal bleed.
- Letrozole 2.5mg daily on days 3-7 of the cycle (Specialist only).
- Letrozole for ovulation induction is an off-label indication. Counsel patient and obtain patient consent.
If letrozole cannot be used:
- Clomifene, oral, 50 mg daily on days 5–9 of the cycle (Specialist only).
- Monitor the progress of ovulation.
For hyperprolactinaemia after further investigation:
See Prolactinoma.