Infertility is classified as a disease by the WHO and is recognized to have significant impact on the lives of the couples it affects. It is defined by the WHO as the failure of a couple to conceive after 12 months of regular, unprotected intercourse and is estimated to affect 1:7 couples. To determine the underlying cause of infertility, both the female and male should be investigated in parallel. In approximately 40% of couples there is a coexisting male and female factor contributing towards infertility. Assessments should begin after 12 months unless the female age is over 35 years or there are known risk factors, when investigations should be implemented sooner. There is a responsibility of the clinician to explore other avenues of parenthood for couples from the outset, as it is important to manage patient expectations and acceptance of childlessness if treatments fail.

Key Learning Points

1. 1. Pulmonary hypertension (PH) is present when the mean pulmonary arterial pressure is ≥25 mmHg at rest.

2. 2. The World Health Organization classifies PH into five groups.

3. 3. Clinical features of PH may be non-specific, and thus challenging to recognise.

4. 4. Identification and treatment of any potential reversible causes are fundamental to the management of PH.

5. 5. PH is progressive and can be fatal if untreated.