Fertility and Reproductive Endocrinology

COVID-19:

The clinical evidence relating to the risks of COVID-19 infection and pregnancy is in the substantive Coronavirus (COVID-19) infection in pregnancy clinical guidance available on the RCOG website.

Covid vaccination is now recommended for pregnant women and the evidence is that it does not cause associated harm The RCOG strongly encourages pregnant women to be vaccinated and provides Covid vaccination guidance and please see the current Green Book COVID-19 chapter for the most up to date information.

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

Services include:

Fertility Investigations
Diagnostic Semen Analysis
Ovulation Induction
Fertility Preservation for Oncology
IVF/ICSI
Pre-Implantation Genetic Diagnosis (PGD)
Donor Insemination
Egg/Sperm Donation
Fertility Counselling
Reproductive Endocrinology

Fertility Services:

Pre-Conception advice and information, includes advice about the Zika Virus.

Please see the Primary Care Management page for further information on initial investigation of infertility.

For advice about the use of medications in pregnancy, please see the Bumps website.

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) should be referred with her partner’s details for further clinical assessment and investigation. Please note that the EFC cannot offer assessments to women aged over 44.

Earlier investigation and referral for specialist consultation should occur where:

The woman’s age is 36 or older
There is known clinical cause of infertility or a history of predisposing factors for infertility in either partner.

EFC Pathway — flowchart courtesy of NHS Lothian

C.M. & D.W 15-03-23

Referral Guidelines

Please see the Primary Care Management page on the investigations required prior to referral. To assist us in supporting your patients please include the following information in your referral:

How long the couple have been trying to conceive
Pregnancy history for both the female and male partner
Description of female partner’s menstrual cycle

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.

Please note that access to fertility treatment is dependent on female partner’s BMI and age. If BMI >30, please discuss weight management with patient and refer as appropriate.

If patients wish to explore IVF/ICSI care pathway, please see IVF details on RefHelp 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. Please note that the criteria for IVF and ICSI are identical.

Please note that 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.

For transgender patients requesting fertility preservation, the EFC only accepts referrals from the Chalmers Gender Identity Clinic. Please direct these patients there in the first instance.

Who not to refer:

Please do not refer if the female partner is > 44 years of age, as there are no treatment options available in EFC. Patients can consider self-funded/ private egg donation treatment: please refer them to the HFEA website.

How to refer:

Please use SCI Gateway >Edinburgh Royal Infirmary >Gynaecology >Infertility.

NB. 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 SCI Gateway) or to sign a consent form giving permission for this, as required under the GDPR regulations.

Secondary care (emergency) referrals

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 acu@nhslothian.scot.nhs.uk and immediately follow up with a telephone call to 0131242 2450 / 2446
Sperm storage	Submit completed form via email to RML.enquiries@nhslothian.scot.nhs.uk 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 the woman’s 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.

Primary care management

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 preconception advice.

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

Have had a semen analysis performed
Consent to including his details in the woman’s referral: the semen analysis SCI Gateway protocol now includes a tick box for this. This is required for GDPR.

Fertility Investigations required before SCI Gateway referral:

Male Partner	Female Partner
Semen analysis x 1. Please see full semen analysis details: if the first sample is abnormal, please arrange a repeat test. 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. 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. If absent or infrequent menses i.e. cycle length > 38 days. LH, FSH, E2, Prolactin, Testosterone, TFTs Taken during first 5 days of menses, or if amenorrhoeic, at any time.
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. Rubella testing is no longer recommended in the UK as part of preconception care.