Guidelines for Fertility Investigations

Fertility investigations should start if the female patient is under 35 and has been trying to conceive for 12 months OR is over 35 and has been trying for 6 months. Flinders Fertility typically orders the following tests however if there are time constraints GPs can order these:

Female Investigations

Preconception Screen:

• 3 Gene RCS
• Expanded Carrier Screen (optional - Medicare does not cover the cost of expanded carrier screening. Out-of-pocket costs are in the region of $600)
• BMI (including weight and height)
• Blood group and antibodies
• FBC (+Iron studies and Thalassaemia as indicated)
• Rubella, Varicella, Syphilis, Hepatitis B/C, HIV serology
• TSH (aim of <2.5)
• Vitamin D

Fertility Hormones:

• Cycle day 2-6: LH, FSH, Oestradiol
• AMH: any day in the menstrual cycle but must not have been using estrogen-containing contraceptive pill or implant for 3 months (Medicare does not cover the costs of an AMH blood test. An out-of-pocket fee of $95 applies)
• Mid-luteal Progesterone (i.e Cycle day 21 in a 28-day cycle)
• Free Androgen Index (FAI), Testosterone, and SHBG if PCOS is suspected

Ultrasound:

• Cycle day 2-6 Pelvic ultrasound (request for Antract Follicle Count)

Male Investigations

• Hepatitis B/C
• HIV serology, Syphilis
• Semen Analysis (SA Pathology or another hospital-grade lab)

Element		Reference
Volume		≥1.5mL
Concentration		≥15million/mL
Progressive motility		≥32%
Normal morphology		≥4%