Female age and fertility referral — DRCOG MCQ

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HardSubfertilityFemale age and fertility referralDRCOG

A 37-year-old woman has been trying to conceive with her partner for 6 months. She has regular cycles and no pelvic pain. She is concerned about age-related fertility decline. When should this patient be referred?

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Correct answer: C — Refer earlier for fertility assessment

The best answer is “Refer earlier for fertility assessment”. NICE advises earlier referral for women aged 36 or over because fertility declines with age and treatment success is time-sensitive. Waiting 2 years may reduce options. Clomifene is not indicated for regular ovulatory cycles in primary care. Male factor assessment should occur early, not after failed treatment. Referral timing depends on age, duration of trying, cycle regularity and known risk factors. Investigation should proceed in parallel for both partners and should not repeat evidence already established. Ovulation assessment, semen analysis and tubal patency answer different components of the fertility pathway.

Reference: NICE CG156: Fertility problems assessment and treatment: https://www.nice.org.uk/guidance/cg156/chapter/Recommendations