Patient journey


The total number of people in the UK who will have difficulty conceiving is estimated to be 1,750,0001. Frequently couples are advised to continue to try to conceive for at least 12 months before seeking medical assistance but for many couples early identification of a problem means that they can get the appropriate help from their GP sooner.

England and Wales

The National Institute for Health and Clinical Excellence (NICE) has provided guidance on the 'Fertility assessment and referral process'2 to assist clinicians in their management of this group of patients:

  • People who are concerned about delays in conception should be offered an initial assessment. A specific enquiry about lifestyle and sexual history should be taken to identify people who are less likely to conceive.
  • People who have not conceived after 1 year of regular unprotected sexual intercourse should be offered further clinical investigation including semen analysis and/or assessment of ovulation.
  • Where there is a history of predisposing factors (such as absence of and irregular periods, pelvic inflammatory disease or undescended testes), or where a woman is aged 35 years or over, earlier investigation should be offered.
  • Where there is a known reason for infertility (such as prior treatment for cancer), early specialist referral should be offered.

Scotland

Although the Scottish Medicines Consortium has not produced any separate guidance for clinicians in Scotland, the Scottish Intercollegiate Guidelines Network (SIGN) has had input into the NICE guidance published in February 20042,3 , and as such the guidance applies in Scotland.


Northern Ireland

Recently, the Department of Health, Social Services and Public Safety (DHSSPS) in Northern Ireland completed a consultation entitled, 'The Future of Fertility Services in Northern Ireland'. The process for patient referral is in line with NICE guidance, however due to finite resources, waiting lists for treatment are inevitable and it may happen that a woman's eligibility status may change on the waiting list e.g. because of age.4


Ireland

According to the Morehampton Infertility Clinic in the Republic of Ireland one in six couples experience trouble conceiving5.Those experiencing difficulty conceiving can have some basic investigations, such as semen analysis and blood tests performed by their G.P.

Most fertility services are privately funded by the patients.

References

  1. Human Fertilisation and Embryology Authority Guide to Infertility and Directory of Clinics 2005/06
  2. Fertility: assessment and treatment for people with fertility problems National Institute of Clinical Excellence Clinical Guideline 11 February 2004
  3. Expert Advisory Group on Infertility Services in Scotland. Evidence and Equity: a National Service Framework for the care of Infertile Couples in Scotland. Scotland: Department of Health; 2000
  4. Future of Fertility Services in Northern Ireland (From People to Parents) - Public Consultation Document October 2003
  5. http://www.infertility.ie Accessed 7 December 2005