Investigations on the NHS

[Futuna]

Hi, I haven't posted here before, but I wanted to find out what other people's experiences of getting investigations done by their GP have been.

Basically I am 38 and have been TTC #2 for nearly 2 years. After about a year I went to my GP and she arranged for a SA test for DH and a blood test for me. The blood test I had done was not on any particular day of the cycle and as far as I can see was just to determine whether I was approaching the menopause or not. When these tests came back OK the GP basically said it was probably down to my age and we should keep trying, however we could be referred if we liked but were unlikely to get very far on the NHS. After thinking about it we asked to be referred privately. I assumed this was for further investigations but we then ended up with a consultation at an assisted conception clinic, where the consultant actually advised that I should have further tests done. However since it was an assisted conception clinic they didn't do test there, so he sent me back to my GP.
On asking the GP if I could have these tests done, basically day 2/3 , 21 and 25 blood tests she said that they wouldn't normally do these on the NHS at this stage. It then turned out she was happy to do them if I paid (£20 each) for them.

Now I'm not really quibbling about £20 and I certainly agree that someone like me with a child already shouldn't get IVF on the NHS, but I didn't think it was unreasonable to expect the basic investigations and that she should have suggested them a bit earlier. Not only this but it seems wrong to me to send us off on the path to an invasive procedure like IVF without having checked that there's not something wrong that could more easily be put right. Also I'm worried that if there is something wrong in the blood tests it's going to be very difficult to get the GP to do anything about it with the response I've had so far. The whole experience has left me feeling very frustrated and powerless.

So after that long post my actual question is have others in their late 30s or TTC #2 had similar experiences with their GPs, is this normal and what can I do about it?

i think this is v. strange. my gp did the day 21 test and dh had his sperm tested and she refered us to the fertility clinic at the same time. can you change gp?

At two years of ttc without success there is likely to be a problem with either one or both of you equally contributing to the subfertility.

You should be referred as a matter of course to a NHS subfertility unit; you should be having nothing less that this currently. Feel that your GP has mucked you about and fobbed you off.

Cannot work out what the day 25 blood test is; this would do presumably what the day 21 would do. Money for old rope springs to mind and there is no guarantee that the blood work result would be interpreted correctly by this person.

"Now I'm not really quibbling about £20 and I certainly agree that someone like me with a child already shouldn't get IVF on the NHS, but I didn't think it was unreasonable to expect the basic investigations and that she should have suggested them a bit earlier. Not only this but it seems wrong to me to send us off on the path to an invasive procedure like IVF without having checked that there's not something wrong that could more easily be put right"

I would totally agree with you with regards to the above comments. I would put this to the GP and consider also changing GP practices.

BTW the GP I had never did any tests but instead referred me to the nearest NHS subfertility unit. Initially at least you are safer under the NHS.

If you do decide to go down the private route do your researches thoroughly beforehand and ask lots of questions re treatments and their success rate. Some private treatment is also poor as well as expensive, it pays dividends to check beforehand and not just go to the first private clinic you see.

Hi Futuna,

No, it is not normal although it maybe indicative of the patchy service that you can get on the NHS. I will be 38 in 2 months time and am also ttc no 2.

I first tried at 6 months to get the basic blood tests done but got told to wait a year (despite the fact that all the fertility boks e.t.c say to go to see your GP after 6 months once you are post 35).

I accepted that at the time and went back after a year, at which point they did a day 21 test which came back normal, but they still referred me at that point to see a consultant. We are seeing her on 23rd August. Prior to seeing her I was told to organise a day 3 blood test, a sperm test for my husband (which he may be doing as we speak!) and also get an HSG done (x-ray of the fallopian tubes)

Really don't understand what on earth your GP is playing at?

Hope you get sorted.

should also have said that all the tests I have mentioned will be done without charge on the NHS

i had a nightmare trying to get our gp to refer us for tests aven after my 3rd consecutive mc, it took seeing 3 docs and eventually losing the plot with one of them and wailing like a banshee for 45 mins (ruined his schedule) you should have been referred earlier and you shouldnt have to pay for basic blood work, can you change gps?

I am quite shocked about this. Who is getting the money for the tests as these are free on the NHS? In addition to changing GPs, I'd actually suggest that you make a formal complaint to your NHS trust about the GP and their attitude.

FYI, I had day 3 tests done a few weeks ago and am having the day 21 ones done later this week (which reminds me need to call practice to book this in!). DH has SA kit but we are hoping (as one always does) that we'll have been successful this month. If not, he will do his bit!

BTW, am 37 (38 later this year) and also ttc #2. Have been formally trying for over a year but have only started charting in past few months so only gotten scientific recently. Not v romantic but worked last time!

That's really poor. The guidelines state that 'people who have not conceived after 1 year of regular unprotected intercourse should be offered further clinical investigation....where a woman is aged 35 or over, earlier investigation should be offered.'
Your GP should have referred you straight to a specialist unit, or requested basic tests and referred you on as well. Definitely under the NHS, absolutely no reason why you should pay, this is what we pay tax for.
Here's the guidelines, they are distributed to GPs.
www.nice.org.uk/pdf/CG011niceguideline.pdf
So I guess you need to go back to your GP and get referred urgently, since it's her fault you haven't been seen sooner, or change GPs first if you can't face an argument. And it definitely merits a serious complaint, absolutely no excuse for this kind of poor service.
Wish you luck.

damn!

I wish i had a copy of those when i got fobbed off by my gp at 6 months, tho don't know if it made any difference that I had had one child without problems.

Think the guidlines do differ if you have had a child with the same partner.

They are guidelines rather than absolute rules, but I reckon it's still useful to know what the recommendations are. Especially if you have a GP who is really crap, like poor Futuna.

I have just had a look at the relevant sections and there is no reference to any difference in approach for those over 35 with, as opposed to without, children.

My GP was not following best practice! the little fxxxxr

the guidelines are generally extremely helpful. thanks for posting the link.

To be fair, bobbydazzler, I seem to remember that if you have already have a child with your current partner then your chances of conceiving again are much higher than say a 37year old with no children. And the guidelines say earlier than 1 year rather than specifically 6 months of trying, so it wouldn't be too unreasonable to suggest you try for a bit longer than 6 months. Maybe 9 months would have been better than a year though. I don't really know much about infertility though, so I'll shut up and go away now.

I hope your right Thursday re my chances of conceiving again being better cos i've had one!

I am just annoyed at myself that I did not push harder a bit sooner when I would have been justified to do so. My husband (who is a doctor himself) was happy for us to wait and I kind off listened to him as well.

Now i have got him fully on board with having tests so i just hope we don't encounter any more delays along the way. I guess that is kind off inevitable though if you stay within the NHS, but we shall see.

Thanks for all your replies. It is reassuring (sort of!) that I was not expecting too much from the GP and that this is not normal.
I think her assumption is that since we have one child then there is nothing basically wrong and so my age is to blame for it taking so long. And to be fair the consultant also thought this was a likely explanation, but still thought other possibilites should be investigated. From my point of view if it is my age then so be it, we're quite prepared to just keep on trying. But I want to eliminate anything else that would be easy to fix, I don't want to just keep on trying, fail and spend the rest of my life thinking 'what if there was something that could have been done'. And to be honest at this stage if there was something wrong which meant we definitely couldn't have another one then I'd like to know, come to terms with it and get on with my life.

Anyway thanks - all the comments have been really useful.

I think for now I will wait for the results of the blood tests and see what she says at that point (luckily the consultant gave me details of what result would be expected and the treatment that should be given). If she's still unhelpful I will insist she refers me - in fact even if she's helpful I'll insist she refers me!

In terms of the other suggestions.

HSG: I did get her also to arrange for this, but again has to be paid for! Are there any other basic tests I should be having?

Changing GPs: I'm thinking about this. Trouble is I do generally like the practice overall and would have to change my DD as well. Could just make an appointment with another GP there but not sure they will go against what a close senior colleague is saying. I will definitely never go to her for anything else again though.

I can't for the life of me understand why you are being told you have to pay! Unless it's to line her Practice's pockets.

We have one child, I had bloods done and HSG on the NHS - free of charge. I most certainly would not have paid to do these. Way I see it, the NHS will not be funding my fertility treatment, ie: IVF, so the least they could do was the bloods and the HSG.

Methinks you need to get a second opinion and also lodge a complaint with PALS (Patient Advice and Liaison Service) because I do think something dodgy's going on.

Hi Futuna
I went to our GP at 40 (was 5 yrs ago) and they did all the tests for free - 3day/14/21 day bloods plus SA for DP

Since then we also had over the past 5 yrs extra free blood tests and SA plus scans, and a removal of a polyp from the womb at the hospital. I can say that both GP and Consultant at hospital have worked with us, we have paid the IVF treatment at another clinic but to save us money our practice does our blood tests that would normally cost £150 a time. I have bartered I must admit but nothing ventured nothing gained. Thoughts like, it will cost them more in money to sort out your stress at not concieving, counselling and continuous visits to GP may help them get it back into perspective.... I think you should ask for your money back ask for a second opinion at the pratice and show them the guidelines. As you are under 40 if you have no kiddies they should be fast tracking you for treatment. I was over 40 and they got me an appointment with a specialist within 3 months. And that seemed too long at the time.
Best of luck!