Initial management of infertility: An audit of pre-referral investigations and exploration of couples’ views at the interface of primary and secondary care

This study aimed to audit pre-referral investigations in primary care, and survey patients' views on the referral process from primary to secondary care. Referral letters and case notes of 250 consecutive couples referred to the Aberdeen Fertility Centre were audited in order to establish whether mid-luteal serum progesterone, rubella status and semen analysis had been performed. Couples attending a specialist hospital clinic for the first time completed a questionnaire on their experience of the referral process and consultation. Mid-luteal progesterone was performed in 105 (51%) cases, rubella status checked in 42 (20%) cases and semen analysis arranged in 70 (34%) cases. Overall, 274 (93%) patients were satisfied or very satisfied with the hospital consultation compared to 216 (84%) who utilisedthe general practitioner (GP) consultation (p = 0.001); 79 (59%) women and 91 (68%) men wanted the current system of GP referral to continue (p < 0.001); and 74 (56%) women and 69 (52%) men (p < 0.001) favoured the option of direct self-referral.

Conclusions: Despite high levels of satisfaction among couples, there is scope for further improvement in terms of pre-referral fertility investigations. Further evaluation of the referral process is needed, and potential changes to the existing system should be considered.