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Fertility problems

  

Infertility is defined as 'failing to get pregnant after two years of regular unprotected sex'.


Subfertility is a problem of a couple, not an individual, therefore all referrals must have male and female history and couples must attend appointments together. Male factor infertility accounts for 30-40%, female 40-50% and combined 10-20%. 92% of couples will conceive within two years.

Do not refer for fertility treatment before 1yr UNLESS:  age ≥ 35yr OR known to have: PCOS OR fibroids OR endometriosis OR previous ectopic pregnancy OR previous pelvic surgery OR PID, infrequent/absent periods, anovulatory progesterone concentrations, endocrine problems, semen abnormalities.

There are five different infertility clinics at UHCW so to enable us to get your couple to the correct clinic the first time we need you to do some initial investigations.

History

We need the following history from both partners (where relevant)

  1. 1. Duration of infertility
  2. 2. Menstrual history
  3. 3. Lifestyle Issues: Smoking, BMI, alcohol, STDs (pelvic/testicular infections), work, stress, diet and exercise routine
  4. 4. Any previous children/pregnancies
  5. 5. Previous contraceptive use
  6. 6. Up to date cervical smears, PMH, FH, DH
  7. 7. Rubella immunisation status
  8. 8. Child welfare issues

Investigations

MALE:

Semen analysis: One semen sample is sufficient if normal. If the first specimen is abnormal, another sample should be obtained, preferably three months later. If the male partner is not registered at your surgery, please advise that he needs to arrange semen analysis through his own GP and state “semen analysis advised” in your referral letter.

Book semen analysis via Choose & Book (not via the Referral Support Service) or use the purple form. See the tab to the right for further information about arrangements for semen analysis.

Semen results can be seen on the Other Events tab of CRRS. Questions about semen analysis should be addressed to either:

 

FEMALE:

  • Full blood count
  • Haemoglobinopathy screen
  • Rubella serology
  • Day 2-3 FSH, LH, Oestrogen, Prolactin, TSH, FT4, Thyroid peroxidase antibody
  • Day 21 progesterone (or 7 days before next period due)
  • High Vaginal Swab and Chlamydia screen (can’t do tubal patency testing without this)

Preconception Advice

  • Folic Acid 400 micrograms/day
  • Reduce alcohol intake, <4 units per week
  • Reduce caffeine consumption, not >1 cup a day
  • Stop smoking
  • Lose weight if BMI >29 or gain weight if BMI <19 (BMI 19-29 for NHS treatment)

Treatment Criteria

Please refer all couples irrespective of the female’s age as the initial investigations can be done on the NHS.

They would then be offered an initial consultation and investigations only.

Those who are not eligible for NHS funding can make an informed decision if they wish to continue their treatment on a self-funded basis or privately.

If they do not wish to pay and not eligible for NHS funding they will be discharged back to GP care.

Local Criteria for NHS funded IUI, IVF, ICSI Treatment

  • Stable relationship for 2 yrs
  • Female aged 23-39
  • Female BMI 19-30 kg/m2
  • Non smokers (both partners)
  • No children under the age of 16 from either partner living with the couple (including   adopted)
  • No previous sterilisation in either partner
  • No previously funded IVF/ICSI treatment
  • No child welfare issues
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