{ "schema_version": 1, "kind": "condition", "id": "infertility-referral", "name": "Infertility (Primary Assessment and Referral)", "category": "chronic", "sources": "NICE Guideline CG156: Fertility problems - assessment and treatment 2017 · Egyptian National Drug Formulary - Blood Disorder Medications 2025 (folic acid monograph) · Female Infertility - StatPearls NBK556033, disease-level clinical article (infertility-referral-full.txt). StatPearls splits infertility by sex; the male side is covered here only through semen analysis", "review_status": "reviewed", "verified_against": "NICE Guideline CG156: Fertility problems - assessment and treatment 2017 · Egyptian National Drug Formulary - Blood Disorder Medications 2025 (folic acid monograph)", "verified_date": "2026-08", "treatments": [ { "id": 983, "generic": "Primary assessment, lifestyle advice, and specialist referral", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Refer couple for specialist fertility assessment after 12 months of unprotected intercourse (or after 6 months if female age >= 35 or known risk factors). Initiate baseline primary care tests: male semen analysis, female mid-luteal progesterone (day 21 of a 28-day cycle; adjust later for longer cycles per NICE CG156), pelvic US, and Rubella immunity verification (reserve FSH/LH/TSH for irregular cycles per NICE CG156).", "adult_duration": "Initial 3-6 months evaluation and referral", "dose_source": "NICE Guideline CG156: Fertility problems - assessment and treatment 2017", "rationale": "Empiric drug therapy (e.g., clomifene or gonadotropins) should NOT be initiated in primary care without specialist diagnosis and monitoring", "cautions": [ "Do not prescribe empiric ovulation induction agents in primary care due to risk of multiple pregnancy and ovarian hyperstimulation syndrome (OHSS).", "Advise intercourse every 2-3 days throughout menstrual cycle rather than timing strictly to ovulation predictors to reduce stress.", "Screen both partners for smoking, obesity (BMI > 30), excessive alcohol, and occupational toxin exposure.", "Verify Rubella immunity status prior to pregnancy (offer MMR vaccination if non-immune, avoiding pregnancy for 1 month post-vaccination) and perform Chlamydia screening prior to uterine assessment or specialist referral (NICE CG156)." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "infertility-referral" }, { "id": 984, "generic": "Folic acid", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 0.4, "adult_dose": "0.4 mg (400 mcg) once daily for female partner before conception and until 12 weeks of pregnancy (use 5 mg once daily if high risk: diabetes, BMI > 30, anti-epileptic drug, or prior NTD)", "adult_duration": "Pre-conception until 12 weeks gestation", "dose_source": "Egyptian National Drug Formulary - Blood Disorder Medications 2025 (folic acid monograph)", "rationale": "Vitamin supplement added during infertility assessment to reduce the risk of neural tube defects if conception occurs; it is preconception care, not a treatment for the underlying cause of infertility, and the dose is increased for higher-risk women.", "cautions": [ "High-dose 5 mg daily is required for women with BMI > 30 kg/m², diabetes mellitus, anti-epileptic therapy, or personal/family history of neural tube defects.", "Folic acid does not treat underlying infertility but is essential pre-conception care to prevent neural tube defects.", "May mask hematological symptoms of vitamin B12 deficiency in rare cases." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not applicable", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "FOLICUREX 400 MCG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MULTICARE", "price_egp": 96.0, "pack_count": 30, "unit_price": 3.2, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FOLIRAQ 400 MCG TABS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HP PHARMA", "price_egp": 42.0, "pack_count": null, "unit_price": null, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FOLIC ACID 400 MCG 250 TABLETS (ILLEGAL IMPORT)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PURITANS PRIDE", "price_egp": 26.0, "pack_count": 250, "unit_price": 0.1, "strength_mg": 0.4, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FOLIDDOX 400 MCG / 5 ML LIQUID 150 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MADDOX PHARMA", "price_egp": 150.0, "pack_count": null, "unit_price": null, "strength_mg": 0.4, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "infertility-referral" } ] }