Fertility and Reproductive Endocrinology

The Edinburgh Fertility Centre and Department of Reproductive Endocrinology is based at the Royal Infirmary of Edinburgh.

SERVICES INCLUDE

Reproductive Endocrinology
Fertility investigations and counselling
Diagnostic semen analysis
Ovulation induction
Fertility preservation for oncology
IVF/ICSI
Pre-implantation genetic diagnosis (PGD)
Donor insemination
Egg/sperm donation.

FERTILITY SERVICES

Please also see:

details of the Edinburgh Fertility Service (EFC)
the Primary Care Management page for further information on initial investigation of infertility
Pre-conception advice and information
advice about the use of medications in pregnancy: the Bumps website.

Following referral, and depending on the clinical picture, the management options for infertility may include:

Sperm – discussion of IVF with ICSI treatment
Absence of sperm – investigation into the cause of this and discussion of options for surgical sperm retrieval and treatment using donor sperm
Ovulation – test of tubal patency and discussion of ovulation induction treatment
Unexplained at present – test of tubal patency and discussion of IVF treatment
Same-sex female couple – discussion of options of insemination treatment or IVF using donor sperm
None of the above – discussion of further investigations and treatment options.

In those where the referred woman is aged 40-42, an initial assessment will be made of the chances of success and the couple then advised whether or not further investigation will be taken forward.

When to investigate and refer

People who are concerned about delays in conception should be offered an initial assessment in primary care.

A woman of reproductive age who has not conceived after 12 months of unprotected vaginal sexual intercourse (in the absence of any known cause of infertility) can be referred with her partner’s details for further clinical assessment and investigation.

But please refer after 6 months if:

Age > 35
previous PID
previous ectopic pregnancy
history of pelvic surgery.

Immediate/Early Referral:

Male partner any age with abnormal semen analysis, previous urogenital pathology / surgery / STI / varicocele / significant systemic illness / abnormal genital examination / previous cancer treatment.
Irregular / no periods
Severe endometriosis
Blocked tubes
Same sex couples
Family history of early menopause.

THERE ARE NATIONALLY-SET EXCLUSION CRITERIA RELATING TO THE WOMAN, WHO NEEDS TO BE AGED 44 OR LESS, AND HAVE A BMI of 35 OR UNDER. PLEASE SEE FURTHER DETAIL BELOW.

The referral process is that:

ONLY the woman is referred
But she has to have a named partner with whom she is attempting to conceive – that can be same sex
And all male partners need to have semen analysis done in NHS Lothian and written consent for his details to be included in her referral – please see Primary Care Management for further detail.
Same sex couples will still need to have a consent form for the partner of the referred woman – please see Fertility – Same sex couple consent to refer

FERTILITY REFERRAL AND THE WOMAN’S AGE

Please note specific advice relating to the woman’s age:

The EFC cannot offer assessments to women aged over 44, in line with national guidance
Earlier investigation and referral for specialist consultation should occur where:
- The woman is aged 36 or older
- There is known clinical cause of infertility or a history of predisposing factors for infertility in either partner.
Women aged 37 and older will need two sets of hormonal tests, at differing times of the cycle – please see Primary Care Management for further detail.

FERTILITY REFERRAL AND THE WOMAN’S BMI

There are now strict criteria for referral on the basis of the woman’s BMI, determined nationally. These differ according to the various treatment options.

Referrals can ONLY be accepted if the referred woman’s BMI is 35 or under.

However, following referral, there are further BMI restrictions relating to specific treatment options which are stricter:

Oral ovulation induction – BMI <34
Ovulation induction injections – BMI <32
NHS funded IVF/ICSI/donor insemination treatment – BMI <30.

Therefore, those with a BMI of 30-35 should be encouraged to engage with weight management services too. Please refer to the weight management service via the usual route and indicate on the SCI Gateway referral this is for prioritisation to the fertility dietetics service: those patients should then be seen within 12 weeks.

Fertility Clinic Referral Pathway Welcome page DIAGRAM 2nd May 2026 Download

MC& CM 25/6/26

Please see the Primary Care Management page on the investigations required prior to referral.

The GP direct line to triage nurse 0131 242 2449 is available for advice, and please note that there is now a SCI Gateway drop-down for e-advice.

Who to refer

Any woman:

Aged 44 or under who wishes fertility treatment and has not conceived after a year of trying (and sooner if aged over 36 or a known cause / predisposing factors in either partner)
Wishing to explore IVF/ICSI care pathway: please see NHS Lothian IVF details and provide them with a copy of the Access Criteria for NHS IVF Treatment in Scotland to assist in managing their expectations regarding eligibility for NHS funded treatment: the criteria for IVF and ICSI are identical. Couples wishing to be added to the waiting list for NHS funded IVF/ICSI treatment couples must first be seen at the fertility clinic to be assessed against the access criteria.

Referrals for transgender patients requesting fertility preservation can only be made by the Gender Identity Clinic

Who not to refer:

Couples where the female partner is > 44 years of age, as there are no treatment options available in the EFC. Patients can consider self-funded/ private egg donation treatment and can be directed to the HFEA website.
Those where the female partner being referred has a BMI >35.
Those who have not tried to conceive for a year with regular SI (or before that if the woman is aged 36 or older, or the couple has additional risk factors for difficulty conceiving – see above).
Anyone who has been sterilised: the NHS does not undertake reversal (sterilisation or vasectomy), and neither partner is eligible for NHS funded IVF/ICSI or donor insemination if undergone sterilisation (Section 7 NIG, 2016). They can self-fund at an NHS Centre.

How to refer:

SCI Gateway → Edinburgh Royal Infirmary → Gynaecology → Infertility.

Please see above for time thresholds for referral.

Please include:

demographic details of both partners – this will require male patients to have signed for consent when the semen analysis is done (now part of the Semen Analysis Laboratory Form v15) and the partner in a same sex couple to have signed the consent form: Fertility – Same sex couple consent to refer
How long the couple has been trying to conceive
Pregnancy history for both partners
Description of the referred female partner’s menstrual cycle.

Emergency fertility preservation referrals (SECONDARY CARE ONLY)

For patients who want to discuss emergency fertility preservation please phone 0131 242 2450 and email the completed referral form and direct the referral as follows:

Egg / embryo storage	Submit completed form via email to loth.assistedconceptionunit@nhs.scot and immediately follow up with a telephone call to 0131242 2450 / 2446
Sperm storage	Submit completed form via email to loth.rmlenquiries@nhs.scot and immediately follow up with a telephone call to 0131242 2463 / 2456

Primary Care Investigations before referral

Prior to referral the GP needs to undertake several baseline investigations in the woman, and her partner needs to arrange a semen analysis and give informed consent for the inclusion of his details in her referral. Please see the table below for full details. The woman should only be referred to the Edinburgh Fertility Centre via SCI Gateway once these tests are completed: his details will be needed for the woman’s referral.

Please note all female and male tests must be completed within NHS Lothian services: results on tests performed elsewhere will not be accepted.

People who are concerned about their fertility should be informed that over 80% of couples in the general population will conceive within 1 year if:

the woman is aged under 40 years and
they do not use contraception and have regular sexual intercourse.

Of those who do not conceive in the first year, about half will do so in the second year (cumulative pregnancy rate over 90%).

People trying to achieve a pregnancy should be given pre-conception advice.

Also advise:

sexual intercourse 2-3 days a week
both partners to quit smoking, E-cig, vaping (otherwise not eligible for NHS assisted conception)
reduce alcohol intake (and quit recreational drugs, if applicable).

Prior to the woman being referred, the male partner must:

Have had a semen analysis performed: if a second sample is required, the female patient can be referred before that is available
Consent to including his details in the woman’s referral: the Semen Analysis Laboratory Form v15 now includes a written consent section for this and it is also a required field in SCI Gateway. This is required for GDPR.

Prior to the referral for same sex couples:

the partner not being referred will need to consent to her details being included in the referral: Fertility – Same sex couple consent to refer

Fertility Investigations required before SCI Gateway referral:

Male Partner	Female Partner
• Semen analysis X 1 Please see full semen analysis details NB. The EFC can only analyse samples in Edinburgh if the male partner is registered with a GP in the Lothians or Borders. For further information, please refer to NHS Lothian intranet advice: Guidelines for Users of the Reproductive Medicine Laboratory	If cycle regular and age < 37 years: • Progesterone Taken on day 21 of cycle if 28-day cycle, or 7 days before expected menses. • TFTs – any time of cycle within the last year If aged 37 years or more: • Progesterone Taken on day 21 of cycle if 28-day cycle, or 7 days before expected menses. • LH, FSH, E2 Taken during first 5 days of menses. • TFTs – any time of cycle within the last year If absent or infrequent menses i.e. cycle length > 38 days. • LH, FSH, E2, Prolactin, Testosterone – Taken during first 5 days of menses, or if amenorrhoeic, at any time. • TFTs – any time of cycle within the last year
Additional tests may be arranged by the Edinburgh Fertility Clinic, including chromosomal or hormonal assessments if indicated. GPs do not have responsibility for these additional tests.	Combined Chlamydia and Gonococcus swab (desirable but not obligatory).
	Dates of 2 X Rubella/MMR vaccinations where available. Please encourage MMR vaccination when rubella vaccination status cannot be confirmed, but referrals are now accepted without this detail. Please see further information on MMR vaccination and pregnancy and Lothian vaccination arrangements Rubella testing is no longer recommended in the UK as part of preconception care.