Subfertility affects 1 in 6 couples in the UK. in the initial GP consultation it is helpful to see both partners together, although this may be difficult in a single 10 minute consultation. In 39% of couples, both male and female factors are responsible for subfertility, with male factors accounting for 30% of subfertility problems. Although this article will focus on female factors, male assessment is important, and a semen sample is one of the first steps in an assessment. If an abnormality is detected in the semen analysis, the test is normally repeated and if confirmed a secondary care referral is required. In 70% of cases a female factor will be the primary cause, and this article will focus on female factors in the more detailed management of subfertility. Subfertility is defined as the inability of a couple to conceive after 12 months of regular vaginal sexual intercourse (two to three times per week). It may be primary subfertility, where the female partner has never conceived, or secondary subfertility, when the female partner has conceived in the past regardless of the outcome of the pregnancy. Recurrent miscarriage is not discussed in this article, but advice can be found in the Royal College of Obstetricians and Gynaecologists (RCOG) Green top guideline no. 17 (RCOG, 2011).
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