Document type
Clinical pathways
East and North Hertfordshire
Output type
Clinical Pathways
Infertility Pathway


Please see attached Infertility pathway

NB: 80% of couples will conceive within 1 year if the women is aged <40, they do not use contraception, and they have regular sexual intercourse (every 2-3 days)

NB: reversal of sterilisation is not normally funded

NB: GPs cannot make a direct referral for IVF/ specialised fertility services.  They should investigate and manage the patient in accordance with the pathway and refer to secondary care only in accordance with the pathway described below.  Secondary care act as gatekeepers for IVF

Summary of Primary Care Management

  • Conduct initial assessment of male and female as per pathway
  • Advise on folic acid and MMR
  • Provide patient information including conception rates
  • Advise on lifestyle management (eg weightloss and stopping smoking)

Conduct further assessment if one year attempt to conceive or six cycles of artificial insemination are unsuccessful

  • Consider male and female causes of infertility
  • Organise for women blood tests cervical smear, chlamydia screening as per pathway
  • Organise for men semen analysis and chlamydia screening (repeat semen analysis in 6 weeks if abnormal)

Assess and manage ovulation disorders appropriately and consider referral to secondary care after all the above

  • Refer to secondary care for further investigations for suspected uterine and tubal abnormalities or abnormalities on semen analysis
  • Refer for unexplained infertility if all hormonal profile and semen analysis normal

Possible indications for early referral include:


  • Age > 35 years
  • Amenorrhoea or oligomenorrhoea
  • Previous abdominal or pelvic surgery
  • Previous pelvic inflammatory disease
  • Previous sexually transmitted infection
  • Abnormal pelvic examination
  • Known reason for infertility (e.g. prior treatment for cancer)


  • Previous genital pathology
  • Previous urogenital surgery
  • Previous sexually transmitted infection
  • Varicocele
  • Significant systemic illness
  • Abnormal genital examination
  • Known reason for infertility (e.g. prior treatment for cancer)

NB: Surrogacy is not funded.