CCFP priority topic 54 of 105
Infertility on the CCFP exam
6 key features, the mistakes that cost marks, and a practice question.
Checked by a Canadian family physician, MD, CCFP. Updated October 20, 2026.
What the exam tests
Key features
The CFPC’s 6 key features for Infertility. Each one below has how the exam asks it, the common mistakes and the approach.
Practice question
Try one before you read
A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.
Key feature 1 of 6
History first
Take a focused fertility history first, then set a sensible time to review.
CFPC skill Clinical reasoningPhase History, treatmentSources Choosing Wisely Canada
On the exam
A couple trying for some months asks if something is wrong. Expect a short menu (pick several from a list) of history questions.
Pick the history questions that change the plan.
Common mistakes
Asking about stress, coffee, posture after sex or past intrauterine device (IUD) use. None explains the delay. Testing early in a young couple with regular cycles is wrong too.
Approach
- Ask how long they have tried, and the woman's age. Both decide how soon you test.
- Ask about cycle length and regularity. Irregular cycles point to a problem with ovulation. Look for its cause.
- Ask how often they have sex, and when in the cycle.
- Ovulation kits or apps can help with timing. Repeated blood tests and ultrasounds to time sex are not needed.
- Ask about past pregnancies, pelvic infection or surgery, and the partner's health and history.
- Set the review date by age and risk. Do not use one fixed two-year wait for everyone.
Key feature 2 of 6
Real odds
Tell people worried about fertility what their real chances are.
CFPC skill Clinical reasoningPhase TreatmentSources Society of Obstetricians and Gynaecologists of Canada
On the exam
A frightened young woman has watched online fertility videos. Expect one best answer for what to tell her.
Pick the most accurate advice.
Common mistakes
Saying all is fine before asking about her cycles. Or saying she will need in vitro fertilization (IVF), which overstates her problem.
Approach
- Age is the main driver. The monthly chance of pregnancy falls clearly after about 32.
- Use the Society of Obstetricians and Gynaecologists of Canada (SOGC) estimates in the table below.
- IVF cannot make up for age. Live births per IVF cycle fall from about 31% at 35 to under 5% at 42.
- Ask about supplements. Inositol, sold online for fertility, has little evidence for pregnancy or live birth.
| Age | Risk of infertility | What to say |
|---|---|---|
| 20 to 24 | About 6% | Most couples this age will conceive. |
| 30 to 34 | About 16% | Odds are still good, but the monthly chance is starting to fall. |
| 40 to 44 | About 64% | Refer now. Treatment with her own eggs works less often. |
Key feature 3 of 6
Older couples
Refer older couples for tests and treatment sooner, since their odds are lower.
CFPC skill Clinical reasoning, selectivityPhase Hypothesis generation, referralSources Society of Obstetricians and Gynaecologists of Canada
On the exam
A woman of 39 with regular cycles has tried for some months. Expect one best answer for the next step.
Pick the best next step.
Common mistakes
Reassuring her and saying try for another year. Or months of office pills to make her ovulate when she already does. Both spend time she lacks.
Approach
- Age 35 to 37: start the fertility work-up after 6 months of trying.
- Over 37: refer to a fertility specialist without waiting 6 months.
- Older women more often have endometriosis, fibroids, blocked tubes or polyps. Ask about pelvic pain and past pelvic surgery.
- Men age too. Semen quality falls with age, and a father of 40 or more counts as older.
- Assess both partners from the start.
Key feature 4 of 6
Both partners
Work up both members of the couple, whether or not they have had a child.
CFPC skill Clinical reasoningPhase Hypothesis generationSources Society of Obstetricians and Gynaecologists of Canada
On the exam
Her partner says it cannot be him: he has a son from an old relationship. Expect one best answer.
Pick the right approach for him.
Common mistakes
Testing her first and him only if her tests are normal. A child from years ago proves little now.
Approach
- Assess both partners from the first visit. A cause in one does not rule out a cause in the other.
- Take his history and examine him. Arrange his tests alongside hers.
- A past child does not settle it. Semen quality and male fertility fall with age.
- Infertility after a past pregnancy needs the same work-up of both partners.
Key feature 5 of 6
Adoption
When pregnancy looks unlikely, bring up adoption at a fitting time, since it is slow.
CFPC skill Patient-centred approach, clinical reasoningPhase TreatmentSources Society of Obstetricians and Gynaecologists of Canada
On the exam
A couple in their late thirties gets hard news after tests. Expect one best answer for what to discuss next.
Pick the right time to raise adoption.
Common mistakes
Raising adoption before any treatment has been offered, which is too soon. Or waiting until every treatment has failed, when years are already lost.
Approach
- Raise adoption once a low chance is clear: after failed treatment, or when age or cost rule treatment out.
- Do not leave it to the end. Adoption often takes a long time, so the talk can run alongside treatment.
- Ask what each partner wants. They may not agree, or be ready at the same time.
- For women over 40 with few eggs left, the SOGC calls donor eggs the only effective option. Name it alongside adoption.
- Name the grief. Offer counselling and support.
Key feature 6 of 6
Irregular cycles
With fertility worries and irregular periods, look for clues that point to a cause.
CFPC skill Clinical reasoningPhase Hypothesis generation, historySources Society of Obstetricians and Gynaecologists of Canada, Choosing Wisely Canada
On the exam
She is 28 with cycles 6 to 10 weeks apart, acne and extra hair. Expect a short menu (pick several from a list) of tests.
Pick the tests her signs call for.
Common mistakes
Ordering repeated hormone tests and ultrasounds through her cycle. Or a chromosome test. Neither directs her care.
Approach
- Look for signs of male-type hormone excess: acne and extra hair. Dark velvety skin folds point to insulin resistance.
- Polycystic ovary syndrome (PCOS) is diagnosed with the Rotterdam criteria.
- Rule out its mimics: high prolactin, congenital adrenal hyperplasia (an inherited adrenal hormone disorder), tumours that make male-type hormones, and Cushing syndrome (too much cortisol).
- Milk from the nipples, headache or change in vision: check prolactin.
- Serial hormone tests are not needed.
- PCOS raises the risk of type 2 diabetes and other metabolic problems.
- Weight loss can help if she is overweight.
| Clue | Think of | Test |
|---|---|---|
| Rare periods, acne, extra hair | PCOS | A diagnosis from the criteria; rule out mimics |
| Milk from the nipples, headache | High prolactin | Prolactin |
Flashcards
Answer it first, then check.
KF 1A couple has tried for 4 months. What do you ask first?
How long they have tried, her age, cycle length and regularity, and how often they have sex.
KF 2She is 23 and scared by online videos. What are her odds?
Good. The SOGC estimates about 6% of women aged 20 to 24 are infertile. Source: Society of Obstetricians and Gynaecologists of Canada
KF 2She is 42 and asks if IVF will make up for lost time. Will it?
No. Live births per IVF cycle fall from about 31% at 35 to under 5% at 42. Source: Society of Obstetricians and Gynaecologists of Canada
KF 3She is 36 and has tried for 6 months. What next?
Start the fertility work-up now. The SOGC advises tests after 6 months at 35 to 37. Source: Society of Obstetricians and Gynaecologists of Canada
KF 3She is 39 and has tried for 3 months. Wait or refer?
Refer now. Over 37, the SOGC advises a specialist without waiting 6 months. Source: Society of Obstetricians and Gynaecologists of Canada
KF 4He has a teenage son, so he says it cannot be him. What do you do?
Test him now, alongside her. Semen quality and male fertility fall with age. Source: Society of Obstetricians and Gynaecologists of Canada
KF 5No treatment has been offered yet. Should you lead with adoption?
No. Raise it once a low chance is clear, and early, since adoption takes a long time.
KF 6Rare periods, acne and extra hair. Which mimics do you rule out before calling it PCOS?
High prolactin, congenital adrenal hyperplasia, tumours that make male-type hormones, and Cushing syndrome. Source: Society of Obstetricians and Gynaecologists of Canada
FAQ
How long should a couple try before you test?
It depends on her age and risk, not one fixed wait. The SOGC advises tests after 6 months at 35 to 37, and sooner after 37. Irregular cycles need a closer look.
Do you need blood tests and ultrasounds to time sex?
No. Choosing Wisely Canada advises against repeated hormone tests and ultrasounds for this. A home ovulation kit or a fertility app can time sex.
Is anti-Müllerian hormone (AMH) a good fertility check?
Not in the office. The SOGC uses ovarian reserve tests like AMH to predict how many eggs a fertility clinic can collect. Her age and cycles guide your work-up.
Sources
Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.
Last reviewed October 20, 2026For exam study. Not advice for a patient in front of you.
- Assessment Objectives for Certification in Family Medicine, 2nd editionCollege of Family Physicians of Canada · 2020
- Choosing Wisely recommendationsChoosing Wisely Canada
- SOGC guidelines and JOGCSociety of Obstetricians and Gynaecologists of Canada