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GP infertility warning

New research suggests GPs are frequently failing to conduct key pre-referral investigations before referring for infertility.

Further problems with GPs' role in managing infertility are highlighted by a second study, which warns that GPs often feel uncertain about how to manage infertile couples.In the first study, an audit of couples attending a fertility centre in Aberdeen revealed that as few as one in three had been given standard investigative tests that NICE recommends GPs should perform.Of 206 referrals from primary to secondary care, mid-luteal progesterone was checked in 51% of women and rubella status in 42% of women. A minimum of one semen analysis was performed in 34% of men.The study, published early online by Human Fertility, concluded: 'Adherence to clinical guidelines regarding infertility management in primary care is difficult to sustain. There is scope for improvement in terms of arranging basic investigations in primary care.'Study leader Professor Siladitya Bhattacharya, head of obstetrics and gynaecology at the University of Aberdeen, defended GPs but speculated they were experiencing 'guideline fatigue' or that infertility was not a priority.'Fertility should be up there with everything else, but usually this is not the case,' he said. 'Avoiding the delays caused by not doing these tests would speed up the journey of infertile couples immeasurably once they arrive in secondary care. That said, most patients were satisfied with their care.'In a separate study published early online by the Journal of Evaluation in Clinical Practice, Dr Scott Wilkes, a clinical research fellow at the University of Sunderland, interviewed 11 GPs about management of infertile couples. Many felt they 'lacked proficiency and had little opportunity to rehearse the necessary skills'.Dr Wilkes, a GP in Amble, Northumberland, said: 'Mid-luteal progesterone, follicle-stimulating hormone, rubella and semen analysis are the absolute minimum. All GPs can do it – whether they all do it is another question.' NICE guidance on infertility recommends that GPs specifically inquire about patients' lifestyle and sexual history and offer semen analysis and assessment of ovulation after one year of failure to conceive.

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