So what is Secondary care and what should you expect to happen?

Well, we want to make sure you understand this, as we don't want you to get to the end of the year and find there is actually a problem because you have been dismissed along the way. 

There are better tests that can’t be done in Secondary Care that can’t be done in Primary Care, which means at the GP and we've discussed them with our resident expert Dr James Nicopollus.

Seeing a gynecologist:

One with a special interest in fertility is key. Women often go to a fertility specialist later, because there is often a delay in referral from GP to Secondary care and then there can be a delay from Secondary Care to IVF. This has been heightened by the Pandemic.

Ideally referrals should happen through the NHS - should come from the GP to a fertility center.

What happens at the referral?

Clinics are trying to do a one-stop-shop. People will have done a semen analysis but will be asked for a report to make sure it is accurate.

GP’s will have tested FSH to check egg reserve and whilst this is OK, it varies between months as well as other variables.

The AMH test is more reliable, as it shows the more follicles you have which is better fertility indicator.

Tubal Patency checks tubes

Important to rule out pelvic issues such as thyroid, polyps, or endometrioma which might impact the outcome.

 If sperm and egg reserve is OK, are you ovulating regularly, with a progesterone check if you haven’t had one?

 Laparoscopy looks inside the tummy with a camera, however, this is done by general anesthetic and this is more likely if there are symptoms of endometriosis

 Most people have a HyCoSy or HSG - inserting dye to screen the fallopian tubes

STI’s such as chlamydia can be silent so these tests are important to exclude them

A complicated appendix procedure could have caused adhesions or any other significant pelvic surgery can cause issues.If there is any suggestion of painful intercourse or painful periods this should be done.

Next, if these tests are clear, in the absence of sub-fertility then an assessment of Sperm DNA fragmentation is needed which looks at the sperm genetic material which can impact natural fertility, IUI, IVF, and ICSI.

Urologists are still not working as much with clinics as they should be

If all these tests are inconclusive and all investigations have been done and you don’t have a diagnosis and you keep trying and it isn’t happening, then the next stage is to go to the fertility clinic for fertility treatment. You should then have your options explained: Continuing naturally, IUI, IVF with the success rates explained 

A lot of people are often well informed, other times incorrectly by Dr. Google, which is why we want to always guide you. The reason people's experiences vary so much in terms of the tests they get access too, is because different clinics and trusts offer different services, and the Doctors in clinics might not map things out correctly. There might also be limitations in funding.

These are all ways in which you might feel you aren’t being guided properly and this is why it is important to become a fertility advocate.

You should always go into a consultation with a list of questions and never feel you shouldn’t ask them.

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