An Audit of Primary Care Investigations Into Infertility Prior to Specialist Referral
This is a two month audit reviewing the assessment and investigation of infertility in Lanarkshire by primary care services.Casenotes of all eligibleattendees to the infertility department of Monklands hospital between September and October 2009 were reviewed to assess the use of appropriate investigations against national guidelines. The Monklands' Infertility Department covers all referrals in NHS Lanarkshire. During the period of the audit, 86 new referrals were received. Of these, only 33 (38%) were asked to provide a sample for semen analysis during the process of referral. 48 female partners had menstruation status noted on referral. 36 were regularly menstruating, but only 22 were asked to provide blood for a day 21 progesterone level. Of the 12 women who were not reguarly menstruating, only 2 were asked to provide blood for hormonal profiling. The NICE guidelines recommend at least one sample be produced for seminal analysis. The NICE guidelines recommend that all women should be asked if they are regularly menstruating, and should receive day 21 progesterone measurements to confirm ovulation. All women who are not regularly menstruating should receive hormonal profiling including LH and FSH levels. The guidelines also recommend that routine screening for thyroid disease or prolactin levels; however 28 women were asked to provide blood for thyroid profiling despite having no history of thyroid disease, and 27 women were asked to provide blood for prolactin levels.
This audit highlighted the significant variation within primary care where investigation of infertility is concerned, and that female partners tend to be overinvestigated compared to male partners. This suggests that a proforma may be useful for the referral process, to ensure that basic investigations are available in order to proceed more rapidly to specialist investigation in secondary care.
Dr Sacha Haworth