{"id":3936,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/fertilityreproductive-endocrinology\/"},"modified":"2025-09-10T08:55:50","modified_gmt":"2025-09-10T07:55:50","slug":"fertilityreproductive-endocrinology","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/fertilityreproductive-endocrinology\/","title":{"rendered":"Fertility and Reproductive Endocrinology"},"content":{"rendered":"\n<p><strong>Services include:<\/strong><br><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Fertility Investigations<\/li>\n\n\n\n<li>Diagnostic Semen Analysis<br><\/li>\n\n\n\n<li>Ovulation Induction<\/li>\n\n\n\n<li>Fertility Preservation for Oncology<\/li>\n\n\n\n<li>IVF\/ICSI<\/li>\n\n\n\n<li>Pre-Implantation Genetic Diagnosis (PGD)<\/li>\n\n\n\n<li>Donor Insemination<\/li>\n\n\n\n<li>Egg\/Sperm Donation<\/li>\n\n\n\n<li>Fertility Counselling<br><\/li>\n\n\n\n<li>Reproductive Endocrinology<br><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Fertility Services:<br><\/h4>\n\n\n\n<p><strong><a href=\"\/refhelp\/guidelines\/PreconceptionAdvice\" target=\"_blank\" rel=\"noreferrer noopener\">Pre-Conception advice <\/a>and information, includes advice about the Zika Virus.<\/strong><span>&nbsp;&nbsp;<\/span><\/p>\n\n\n\n<p><strong>Please see the Primary Care Management page for further information on&nbsp;initial investigation of infertility<\/strong>.<\/p>\n\n\n\n<p>For advice about the use of medications in pregnancy, please see the&nbsp;<span><a href=\"https:\/\/www.medicinesinpregnancy.org\/\" target=\"_blank\" rel=\"noreferrer noopener\"><span>Bumps website<\/span><\/a>.<\/span><\/p>\n\n\n\n<p><strong>When to investigate and refer<\/strong><\/p>\n\n\n\n<p>People who are concerned about delays in conception should be offered an initial assessment in primary care.<\/p>\n\n\n\n<p>A woman of reproductive age who has not conceived after <strong>12 months of unprotected vaginal sexual intercourse<\/strong> (in the absence of any known cause of infertility) should be referred with her partner&#8217;s details for further clinical assessment and investigation. Please note that the EFC cannot offer assessments to women aged over 44. <\/p>\n\n\n\n<p>Earlier investigation and referral for specialist consultation should occur where:<br><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The woman&#8217;s age is 36 or older<\/li>\n\n\n\n<li>There is known clinical cause of infertility or a history of predisposing factors for infertility in either partner.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"\/files\/sites\/2\/EFC-Pathway.png\" alt=\"EFC Pathway\" \/><figcaption class=\"wp-element-caption\">flowchart courtesy of NHS Lothian<\/figcaption><\/figure>\n\n\n\n<p><strong>C.M. &amp; D.W 15-03-23<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Referral Guidelines<\/h4>\n\n\n\n<p>Please see the Primary Care Management page on the investigations required&nbsp;<strong>prior<\/strong>&nbsp;to referral. To assist us in supporting your patients please include the following information in your referral:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>How long the couple have been trying to conceive<\/li>\n\n\n\n<li>Pregnancy history for both the female and male partner<\/li>\n\n\n\n<li>Description of female partner&#8217;s menstrual cycle<\/li>\n<\/ul>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>Please note that access to fertility treatment is dependent on female partner&#8217;s BMI and age. If BMI &gt;30, please discuss weight management with patient and refer as appropriate.<\/p>\n\n\n\n<p>If patients wish to explore IVF\/ICSI care pathway, please see&nbsp;<a rel=\"noreferrer noopener\" href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/invitrofertilisationivf\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/invitrofertilisationivf\/\" target=\"_blank\">IVF details on RefHelp<\/a>&nbsp;and provide them with a copy of the&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Access-Criteria-for-NHS-IVF-Treatment-v12.pdf\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Access-Criteria-for-NHS-IVF-Treatment-v12.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Access Criteria for NHS IVF Treatment in Scotland<\/a>&nbsp;to assist in managing their expectations regarding eligibility for NHS funded treatment. &nbsp;Please note that the criteria for IVF and ICSI are identical.<\/p>\n\n\n\n<p>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.<\/p>\n\n\n\n<p>For transgender patients requesting fertility preservation, the EFC only accepts referrals from the&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/sexualreprohealth\/gender-identity\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/gender-identity-clinic\/\" target=\"_blank\" rel=\"noreferrer noopener\">Chalmers Gender Identity Clinic<\/a>. Please direct these patients there in the first instance.&nbsp;<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<p>Please do not refer if the female partner is &gt; 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&nbsp;<a href=\"https:\/\/www.hfea.gov.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">HFEA website<\/a>.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>Please use SCI Gateway&nbsp;&gt;Edinburgh Royal Infirmary&nbsp;&gt;Gynaecology&nbsp;&gt;Infertility.<\/p>\n\n\n\n<p><strong>NB. Please include demographic details of&nbsp;both&nbsp;partners &#8211;&nbsp;<\/strong>this will require male patients to have signed for consent when the semen analysis is done (now part of SCI Gateway) or to&nbsp;<a href=\"\/files\/sites\/2\/Fertility-Couple-Referral-Form-FINAL-30-Jan-2021.doc\" target=\"_blank\" rel=\"noreferrer noopener\">sign a consent form<\/a>&nbsp;giving permission for this, as required under the GDPR regulations.&nbsp;<\/p>\n\n\n\n<p><strong>Secondary care (emergency) referrals<\/strong><\/p>\n\n\n\n<p>For patients who want to discuss emergency fertility preservation please phone 0131 242 2450 and email the completed&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Fertility-Preservation-Referral-Form-v4.doc\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Fertility-Preservation-Referral-Form-v4.doc\" target=\"_blank\" rel=\"noreferrer noopener\">referral form<\/a>&nbsp;and direct the referral as follows:<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td>Egg \/ embryo storage<\/td><td>Submit completed form via email to&nbsp;<a href=\"mailto:acu@nhslothian.scot.nhs.uk\" target=\"_blank\" rel=\"noreferrer noopener\">acu@nhslothian.scot.nhs.uk<\/a>&nbsp;and immediately follow up with a telephone call to 0131242 2450 \/ 2446<\/td><\/tr><tr><td>Sperm storage<\/td><td>Submit completed form via email to&nbsp;<a href=\"mailto:RML.enquiries@nhslothian.scot.nhs.uk\" target=\"_blank\" rel=\"noreferrer noopener\">RML.enquiries@nhslothian.scot.nhs.uk<\/a>&nbsp; and immediately follow up with a telephone call to 0131242 2463 \/ 2456<\/td><\/tr><\/tbody><\/table><\/figure>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Primary Care Investigations before referral<\/h4>\n\n\n\n<p>Prior to referral the GP needs to undertake several baseline investigations in the woman, and her partner needs to arrange a semen analysis&nbsp;and give informed consent for the inclusion of his details in the woman&#8217;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&#8217;s referral.&nbsp;<\/p>\n\n\n\n<p><strong>Please note all female and male tests must be completed within NHS Lothian services: results on tests performed elsewhere will not be accepted.<\/strong><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Primary care management&nbsp;&nbsp;<\/h4>\n\n\n\n<p>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:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>the woman is aged under 40 years and<\/li>\n\n\n\n<li>they do not use contraception and have regular sexual intercourse.<\/li>\n<\/ul>\n\n\n\n<p>Of those who do not conceive in the first year, about half will do so in the second year (cumulative pregnancy rate over 90%).<\/p>\n\n\n\n<p>People trying to achieve a pregnancy should be given&nbsp;<a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/preconceptionadvice\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/preconceptionadvice\/\" target=\"_blank\" rel=\"noreferrer noopener\">preconception advice<\/a>.&nbsp;<\/p>\n\n\n\n<p><strong>Prior to the woman being referred, the male partner must<\/strong>:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/semenanalysis\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/semenanalysis\/\" target=\"_blank\" rel=\"noreferrer noopener\">Have had a semen analysis performed<\/a><\/li>\n\n\n\n<li>Consent to including his details in the woman&#8217;s referral: the semen analysis SCI Gateway protocol now includes a tick box for this. This is required for&nbsp;<a rel=\"noreferrer noopener\" href=\"https:\/\/ico.org.uk\/\" target=\"_blank\">GDPR<\/a><span style=\"color: initial\">.&nbsp;<\/span><\/li>\n<\/ul>\n\n\n\n<p><strong>Fertility Investigations required before SCI Gateway referral:<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td><strong>Male Partner<\/strong><\/td><td><strong>Female Partner<\/strong><\/td><\/tr><tr><td>&nbsp;Semen analysis x 1. Please see full <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/semenanalysis\/\">semen analysis details<\/a>: if the first sample is abnormal, please arrange a repeat test.<br>NB. The EFC&nbsp;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: <a href=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Reproductive-Medicine-Laboratory-User-Guide-v15.pdf\" data-type=\"link\" data-id=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Reproductive-Medicine-Laboratory-User-Guide-v12.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Guidelines for Users of the Reproductive Medicine Laboratory<\/a><\/td><td>If cycle regular and age &lt; 37 years:<br>         <strong>Progesterone<br><\/strong>        Taken on day 21 of cycle if 28-day cycle, or 7 days before expected            menses.<br><br>If aged 37 years or more:<br>        <strong>Progesterone<\/strong><br>       Taken on day 21 of cycle if 28-day cycle, or 7 days before expected    menses. <br>       <strong>LH, FSH, E2<\/strong><br>       Taken during first 5 days of menses. <br><br>If absent or infrequent menses i.e. cycle length &gt; 38 days. <br>       <strong>LH, FSH, E2, Prolactin, Testosterone, TFTs&nbsp;<\/strong><br>       Taken during first 5 days of menses, or if amenorrhoeic, at any time.<\/td><\/tr><tr><td>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.<\/td><td>Combined Chlamydia and Gonococcus swab (desirable but not obligatory).<\/td><\/tr><tr><td>\u200b<\/td><td>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&nbsp;<a href=\"\/files\/sites\/2\/Rubella-susceptibility-and-MMR-vaccine-pre-conception.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">further information on MMR vaccination and pregnancy<\/a>. Rubella testing is no longer recommended in the UK as part of preconception care. &nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><\/p>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Services include: Fertility Services: Pre-Conception advice and information, includes advice about the Zika Virus.&nbsp;&nbsp; Please see the Primary Care Management page for further information on&nbsp;initial investigation of infertility. For advice about the use of medications in pregnancy, please see the&nbsp;Bumps website. When to investigate and refer People who are concerned about delays in conception should<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3664,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[1],"class_list":["post-3936","page","type-page","status-publish","hentry","category-uncategorised"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/uncategorised\/\" rel=\"tag\">Uncategorised<\/a>","rttpg_excerpt":"Services include: Fertility Services: Pre-Conception advice and information, includes advice about the Zika Virus.&nbsp;&nbsp; Please see the Primary Care Management page for further information on&nbsp;initial investigation of infertility. For advice about the use of medications in pregnancy, please see the&nbsp;Bumps website. When to investigate and refer People who are concerned about delays in conception should","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3936","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3936"}],"version-history":[{"count":26,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3936\/revisions"}],"predecessor-version":[{"id":25254,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3936\/revisions\/25254"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3664"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3936"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3936"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}