Clinical Case Database / Category: Case Based Discussion

The initial investigation of infertility

Publication details

Joanna Clark BM BSc, Valentine Akande BM BSc
Foundation Years Journal, volume 1, issue 7, p.347 (123Doc Education, London, November 2007)


A 34 year old woman has been trying to conceive for 1 year with no success. Neither herself nor her 32 year old male partner have been responsible for a pregnancy in the past.

Further questioning reveals that they have been having regular intercourse at 2-3 day intervals throughout the month. The woman has regular cycles, bleeding for 4 days of every 28, with no menorrhagia or pelvic pain.

Neither have ever knowingly had an STI and both are fit and well with no significant past medical or family history. The male partner has a BMI of 32, and the female 29. They do not have occupational exposure to any chemicals, radiation or driving long distances and neither takes medications. They consume less alcohol than the recommended maximum weekly limit on average, but the woman smokes 5 cigarettes a day.

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Joanna Clark BM BSc (Corresponding author)

Specialty Trainee Obstetrics and Gynaecology
Department of Women and Childs Health
Southmead Hospital
Southmead Road
BS10 5NB

Valentine Akande BM BSc

Consultant Obstetrician and Gynaecologist
Department of Women and Childs Health
Southmead Hospital


1.  NICE Clinical Guideline 11, Feb 2004. Fertility: assessment and treatment for people with fertility problems.

2.  World Health Organisation. WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction. Cambridge: Cambridge University Press 2000.

3.  Balen, A.H., Rutherford, A.J. Management of Infertility. BMJ 2007; 335:608- 11.

4.  Bolvin, J., Bunting, L., Collins, J.A., Nygren, K.G. International estimates of Infertility prevalence and treatment seeking: potential need and demand for infertility medical care. Hum Reprod 2007; 22: 1506-12

5.  Khalaf, Y. ABC of subfertility. Tubal subfertility. BMJ 2003; 327: 610-613

6.  Kull, M.G., et al. Population study of causes, treatment and outcome of infertility. BMJ 1985; 291: 1693-7.

7.  Ross, J. United Kingdom national guideline for the management of pelvic inflammatory disease. British Association for Sexual Health and HIV February 2005.

8.  Templeton, A. The management of infertility. In: Management of infertility for the MRCOG and beyond. Templeton, A., et al. RCOG Press 2003.


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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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