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Unfair to criticise GPs' infertility care

Critical comments on GP management of infertility (News, 3 May) cannot be allowed to go unchallenged.

I speak as one who has often prescribed clomiphene with good results and I remember clearly the bad old days of the early 1990s when it seemed like it took about 18 months to get on the waiting list for the infertility centre. Of course I investigated my patients properly before treatment and at the start I nagged specialists for telephone advice.

Recently I have done far less infertility management because I have seen so many dire warnings from so-called experts about the dangers of using clomiphene without regular ultrasound examination. If it is so dangerous, runs my thinking, then let the experts handle it.

As for specific tests, why check the progesterone level when we are discouraged from doing anything about it? Why check rubella status when nearly 100% of women are immune? And it is normally only done in women who are already pregnant. Is there something I'm missing here?

And don't get me started on semen analysis. That used to be done in our local bacteriology lab, without appointment, and I always got a verbal report from the lab tech the same day. Now, in some move that supposedly improves patient care, I have to refer my patients to another hospital lab which is a lot further away. At last check, the waiting list for semen analysis was six months.

Now we are told doing the tests in general practice will speed things up when the patient gets to the clinic. Personally I'll do the tests anyway as part of my last feeble attempt to get some minimal intellectual stimulation from working as an overpaid statin dispenser in the modern NHS. Let's look at the speeding things up argument. Does a full pre-referral work-up 'speed the journey of infertility couples immeasurably once they arrive in secondary care'?

I really cannot see how a few results will make much difference to the journey time – about 99% of which is spent waiting for an appointment.
From Dr Declan Fox, Newtownstewart, County Tyrone

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