Subfertility & Reproductive Endocrinology
Assess fertility concerns jointly and recognise when earlier specialist input is needed.
Quick revision ↓ Medical Dictionary
01Initial assessment
Ask about the duration of attempts, menstrual pattern, previous pregnancies, sexual function, medical history and relevant exposures in both partners where applicable. Avoid assigning responsibility before assessment. The timing of investigation depends on age, duration and known risk factors. Earlier referral is appropriate for suspected causes or planned treatment that may impair fertility.
02Investigate both partners
Semen analysis, assessment of ovulation and evaluation of tubal or uterine factors address different parts of the fertility pathway. Choose tests according to history and specialist guidance; one normal result cannot establish that all reproductive function is normal. Explain preparation and limitations, and arrange review of results rather than leaving patients to interpret numbers without context.
03Ovulatory disorders
Irregular or absent cycles may suggest anovulation, but consider pregnancy, hypothalamic factors, thyroid disease, hyperprolactinaemia and ovarian insufficiency as appropriate. Polycystic ovary syndrome requires a clinical assessment and exclusion of relevant alternatives; ovarian appearance alone is insufficient. Management addresses reproductive goals and metabolic health, with specialist fertility treatment where indicated.
04Treatment principles
Discuss options according to the identified cause, age, prognosis and preferences. These may include targeted medical or surgical treatment and assisted conception. Explain realistic chances, burdens, risks such as multiple pregnancy or ovarian hyperstimulation, and the potential need for several steps. Treatment selection should follow current specialist guidance rather than a universal progression for every patient.
05Support and preservation
Fertility difficulties can cause distress and strain relationships, so offer psychological support and clear information without promising success. Discuss preservation before potentially gonadotoxic treatment when feasible, with urgent specialist coordination. Review lifestyle and preconception health without blame. Shared decisions should include the option to pause or stop treatment as well as continuing it.
High-Yield Revision
- Assess both partners where applicable.
- Earlier referral is appropriate with known risks or advancing reproductive age.
- A single test does not establish overall fertility.
Common Pitfalls
- Diagnosing PCOS from ultrasound appearance alone.
- Promising a guaranteed assisted-conception outcome.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.