Questions for your GP
We know fertility journeys can be overwhelming. We have prepared a few questions that we think may start some good conversations with the medical professionals helping you on your fertility journey.
Questions to ask my GP?
- Will my health conditions affect my fertility?
- How will my medications affect my fertility?
- Should I take vitamins or supplements?
- Should I change my exercise routine or other lifestyle habits?
- Do I need any vaccinations?
- Why can't I conceive?
- What tests should I have?
- Do I need specialist help?
- How can I access counselling?
Questions to ask my fertility specialist?
- What is my diagnosis?
- What treatment should I start with?
- What are my chances of success?
- What costs does this treatment involve?
- Are there additional procedures that need to be added to my treatment plan? If so, what are these? What are the extra costs?
- Do you support complementary treatments?
- Who will contact me about test results, appointments and decisions about the next phase of treatment?
- If I have any further questions, who can I contact?
- Do we eligible for publicly funded fertility treatment?
- How do I find a donor or surrogate?
- Do you offer counselling, and how can I book an appointment?
- Can I have a written explanation of what we discussed at my appointment?
What a GP should cover.
Questions about:
- Lifestyle, especially alcohol, caffeine, drugs, exercise, weight gain or loss, smoking
- Taking folic acid
- Use of alternative or complementary medicine
- Occupational exposure to potential hazards, especially heat for the man
- Menstrual cycles
- Fertility in any previous relationships
- Previous surgery
- Testicular injury
- Possible Pelvic Inflammatory Disease (PID) or Sexual Transmitted Disease (STD)
- General health
- Investigations and checks
- Up to date cervical smear
- Rubella vaccination
- Blood test for FSH and possibly progesterone (the woman)
- Semen analysis
- Physical examination of both partners
- Referral for tubal patency by laparoscopy or hysterosalpingogram (HSG), depending on what else is found.
Offer prompt referral to a fertility specialist if any of the following:
- Any abnormal or unusual findings from your medical history, examination or tests
- You have been trying for more than 12 months
- You have been trying for more than six months, and you (the woman) is younger than 27 or older than 35
- Close members of your family having had menopause before the age of 40
- Two or more consecutive miscarriages
- You want action now
Types of referral that should be offered
- Offer of public referral to a fertility clinic if you meet the eligibility criteria (the consultation is free, but you may need to wait)
- (For this type of referral, the preliminary tests need to be finished. In some areas, there are extra restrictions around the woman’s age and BMI that tie in with eligibility for publicly funded treatment)
- Offer of private referral to a fertility specialist or clinic (you pay for the consultation)
- You can make an appointment with a fertility specialist without a GP referral.
For GPs – what to cover in a fertility consultation
Check:
- Rubella status
- Recent cervical smear
- Medical history, including drug use and occupational exposure
Advice:
- Women to take folic acid
- Stop smoking
- Lose weight if BMI above 28
- Gain weight if BMI below 19
- Minimise caffeine and alcohol intake for both partners
- Have intercourse every two days or so around the middle of the menstrual cycle
Investigate:
- History around weight gain or loss if ovulation is irregular
- Prolactin and thyroid function only if cycles are irregular
- FSH and estradiol around day 2 of the menstrual cycle – estradiol needs to be below 300 pmol/l to interpret basal FSH correctly
- Semen analysis, and repeat in 4-8 weeks if any aspect is below the reference range
- Unless very irregular or absent cycles or poor semen quality, Tubal patency is required for public referral in most areas.
Refer to a fertility specialist
- Not pregnant after 12 months OR
- Not pregnant after six months if woman younger than 27 or older than 35, OR
- Family history of menopause before 40, OR
- More than two consecutive miscarriages, OR
- A genetic condition related to fertility, OR
- If any abnormal results from investigation, examination or medical history, including:
- Previous abdominal, pelvic or urogenital surgery on the woman or man
- Previous PID or STD
- Significant systemic illness
Our Green Prescription, popular with GPs, summarises how you can maximise your chances of conception.
