OH in military complicating/preventing fertility referral

[pjmeek82]

My GP has carried out all of the tests I need for a fertility referral in our area, all that she needs in order to send off the referral form is my OH's semen analysis results. We are being referred on account of my age (I'm 37) and raised titres in my chlamydia serology indicating previous exposure (although to my knowledge I've never had chlamydia). She has never had to refer a couple who aren't both registered at the same practice before. Because my OH is in the military and I'm not, he has military GP and I have a civilian NHS GP.

The problem is that his military GP is telling my OH that he is unable to order a semen analysis for him and that my GP should order this for him instead. My GP is adamant that she can't order his semen analysis because my OH isn't my GP's patient, she therefore doesn't have access to his records, medical history, etc. So we're in a catch 22 situation where we can't get the fertility treatment referral because my OH's GP says he can't order his semen analysis and we need the results of that analysis for my GP to refer us.

Has anyone else experienced this problem? How was it resolved? I'm feeling as if our chances of having a baby are screwed simply because a military GP won't order a semen analysis for my OH and my GP is unable to do so because my OH isn't her patient: without it we can't get a fertility referral. We've been trying for a while now and as I'm getting older, our chances of spontaneous conception are dwindling.

Hi @pjmeek82. I might be able to help. My DH is in the military and we have successfully secured funding for ivf after a long and complicated process. If you want to PM me I can answer your questions and try and help you through the process? Hope that helps?

What’s stopping your OH from registering as a patient for as long as you need fertility testing, then swapping back to his usual one once it’s done? Is there some sort of rule that says he absolutely has to use the military one? Or could he register as a temporary patient?

To be honest; surely the military have a duty of care to give him access to medical care as good as he would receive in civilian life, which includes fertility treatment if necessary? Can he raise it with his boss/CO/NCO? Or is there some sort of “well-being” contact he could try?

So few questions to ask first off:
-have you got any previous children? That will stop any treatment dead in the water?

• Your DPcan’t register with a ‘normal gp’ that’s not how it works in the military.
• the military gp is not being truthful with your DP. He can absolutely order a semen analysis for him. My DH had all three done and ordered through the military.
• there is something called a DIN (defence information notice) for assisted conception in the military. It outlines what you are entitled to. Although if you are not married this might have an effect. (Military are stuck in the 1950s!!) if you pm I can send you the link to the DIN
• in order to apply for help with assisted conception there are A LOT of hoops to jump through. It tools us about 18 months even with a very clear reason as to why we couldn’t conceive naturally.

Finally just a thought. Could it be that your partner is reluctant to go for a sperm test and is stalling? I know it’s scary time but both of you absolutely have to be on the same page with fighting infertility.

Hope this helps

@Whatelsecouldibecalled I will DM you.

@Dyrne his primary care is through the military and most medical stuff he needs is dealt with through military drs. When they can't give him care he needs, e.g. when he needed an operation following a sports injury, they refer him to NHS or private services (which are then paid for by the military). His military GP said that in mixed marriages (one spouse in military, one not), all fertility stuff is always dealt with by the civvy GP, but this can't be correct because my GP said there is no way she is physically able to request the semen analysis when he isn't her patient. My GP can do the referral and we will see NHS fertility specialists once the referral happens, but without the semen analysis we can't get that far.

My OH is suggesting registering at a civvy practice, but at this stage I'm not even sure he's allowed to, or if this would even be a good idea as it will likely interfere with other medical stuff he has that's ongoing. Generally, things happen more quickly in the military than on the NHS, e.g. physio referrals are much quicker in the military, as are mental health referrals, etc, plus he gets free prescriptions from his military GP and so on.

Things are further complicated by the fact that I am a PhD student and stupidly registered with the student health centre (even though it's 90 minutes away) when I started my degree because I thought that would be more convenient than registering at our local practice. As he isn't a student, he can't register with my GP clinic, even as a temporary patient. I could switch to our local practice and he might be able to do that too, but I'm worried that it would mean starting everything over again after having built a relationship with my GP who has been very helpful and supportive.

He's an officer, so complaining to someone more senior would be making big waves, at this stage we're just trying to figure out whether the GP he has is misinformed by thinking he can't order the semen analysis, or whether it is actually a brick wall we can't get over.

Ah I thought that might be the case Whatelsecouldibecalled re:military vs civilian GPs; thanks for clarifying.

Good luck pjmeek82 ; hopefully you can get to the bottom of things! If you don’t want to make waves is there any other support he could access that might be able to help him advocate for himself? Thinking someone like a Chaplain etc?

Obviously this isn’t ideal and would only be possible if you have the budget, but is private testing via a fertility clinic possible? For just a sperm analysis I don’t believe it’s very expensive (though it will depend on where you are in the country) and you will get a report which you could take to your GP. I do appreciate that that shouldn’t be necessary, but it is one way to solve the issue.

As it's just one test, could your DH approach a private GP and ask the analysis to be done there? Have no idea of costs involved but for the sake of speed and a couple of £100, might be worth looking into. Local private hospital with a urologist might be able to help

We temporarily registered my DH at my GP surgery for this exact reason and the semen analysis was sent to the civvy GP and a copy sent to the military one.

Your civvy GP just doesn't know what they are about on this one.

I would strong recommend NOT registering at a civvy GP. There is a standard protocol for assisted conception the in military. The military doctor is incorrect. I was civvy registered as I’m not military and DH is military registered and we eventually got the help we needed. Just have to know what lines to say.

It’s tough. I’ll wait for your DM @pjmeek82.

Was it the SMO who said that to him? If not I would escalate to SMO and Practice Manager, someone is going to have dealt with this I'm sure. If the med staff aren't being helpful I would raise it with welfare and/or Army/RAF/Navy Families Federation for some extra weight to get things going quicker. I have a couple of friends who have had fertility treatment in a similar situation so it's probably just something the military GP hasn't dealt with before....frustratingly.

Who’s your MP? Hopefully an established one... it might sound random, but getting over random bureaucracy and forcing everyone to see sense is something they’re very good at..

@CornishPorsche I'm amazed you were allowed to do that, I assumed they had to be with the military doctors.

OP are you married, can you sign up to his med centre?

@Whatelsecouldibecalled

So few questions to ask first off:
-have you got any previous children? That will stop any treatment dead in the water?

We don't have any other children, we are eligible for treatment under the rules for the area we live in and because of my age my GP can do a fast track referral, as in, we don't have to wait six months/a year/two years of trying to get a referral.

• Your DP can’t register with a ‘normal gp’ that’s not how it works in the military.

Thanks for confirming this, this is what I thought.

• the military gp is not being truthful with your DP (darling partner). He can absolutely order a semen analysis for him. My DH (darling husband) had all three done and ordered through the military.

My assumption is that the GP just doesn't realise he can order the analysis, I think his GP is getting confused and thinks my OH was talking about the referral when they met yesterday. My OH went back to his GP today and specified that it was just the semen analysis he needed and my GP would manage the referral, but his GP is still adamant he can't order it.

• there is something called a DIN (defence information notice) for assisted conception in the military. It outlines what you are entitled to. Although if you are not married this might have an effect. (Military are stuck in the 1950s!!) if you PM (Private message) I can send you the link to the DIN

Will PM you for the DIN, I found something in MOD docs regarding time off for treatment and for my OH to accompany me to antenatal appointments, but nothing regarding assisted conception.

• in order to apply for help with assisted conception there are A LOT of hoops to jump through. It tools us about 18 months even with a very clear reason as to why we couldn’t conceive naturally.

My GP is confident it'll happen quite smoothly once we get the referral because of my age and the raised serology titres. Although she said she wasn't sure how long the waiting list was and I wouldn't be able to find that out until I get referred.

Finally just a thought. Could it be that your partner is reluctant to go for a sperm test and is stalling? I know it’s scary time but both of you absolutely have to be on the same page with fighting infertility.

He's really keen to start our family ASAP, so I doubt it's that. We have no reason to think there is anything wrong with his sperm so I doubt he's having concerns over worrying if he's the problem, there's been no indication that it is causing him any anxiety, etc.

My age seems to be the main issue as far as my GP is concerned. As far as the referral goes, the semen analysis is just a tick in a box on the referral form to move things forward. As soon as my GP said all she needed was his semen analysis, the first thing he did when he got back to the office was book in with his GP to ask him about it. We had hoped that he could get the analysis done before Christmas so that my GP could complete the referral before the end of the year.

@BacktoMA it was done in discussion with the PMO, following them refusing to refer me along with DH. GPs both said we would need to be referred together by one GP, even though DH was the infertile one.

He also has had to use OOH GP services at weekends etc for things like cellulitis, because the RN ones are only open for fresh cases Mon to Fri at 0730. They just send the details of the appointment to the RN.

If your hospital is like ours, you'll have to book an appt for the semen to be taken in (you have tight times for this to be done). We had to wait 5 weeks for an appt then 6 weeks for the result to come through.... My Xmas is very ambitious.

Also, DH's results were catastrophic for us, so never assume its a tick box exercise.

@pjmeek82

Hopefully you will get fast tracked. I’m not sure with age as I am 31 (30) when we started the process. My DH has a poor semen result. So much so that it was highly unlikely we would ever conceive without some help. This was supposed to then fast rack a referral. Despite this we still had to complete the following tests:

• all blood work for me x 2
• all blood work for him x 2
• semen analysis tests x 3 each 3 months apart
• pelvic ultrasound for me
• HSG for me
• HIV/HEPATITIS A/B:C and rubella screening for me and him.

Only at that point could we apply to referral for assisted conception. This took about a year in all to get sort in between deployments. We then got rejected for funding 3 different times with no reasons given. So had to apply all over again.

Through the DIN you are entitled to 3 funded rounds of ivf (as per the NICE guidelines) if you meet the strict criteria that is outlined in the DIN. This is because sadly despite the NUCE guidelines saying that everyone should be entitled to 3 fully funded rounds it is down to the local CCG where you live of how many rounds are funded. Which is obviously appalling. The military view on it is that it is their fault we live where we do because of DH job and there should be able to access the 3 full rounds. So although it’s a lot of hops to jump through it’s more than worth it for this alone.

You are able to book an appointment with the base med centre for you both to attend and discuss options. I went armed with information and I’m quite a pushy person but they were very supportive. So 2 years or so down the line we finally started treatment.

@BacktoMA his appointment with with a PMO, so potentially he could escalate it to a SMO.

@CornishPorsche I'm really glad they allowed it! I didn't realise it was an option.

Just as an update for anyone looking for info in the future, his dr required something in writing from my dr stating my dr couldn't refer him because he isn't her patient. Once my OH's dr saw the email he (reluctantly) referred my OH, still insisting that in all other cases he'd seen in the Navy, the semen analysis referral was made by the wife's GP. My OH called the fertility clinic to make an appointment but they were full up for a month so he was told he was on the waiting list and they'd be in touch when they were getting ready to schedule the next batch of NHS appointments. He got a call today from them letting him know they were ready to start booking in the next batch of appointments, they confirmed his details, and said he'd receive an appointment letter soon. So hopefully he'll be able to get his semen analysis in the next couple of weeks and then my dr can complete the referral.

We are obviously really frustrated because we hoped he could have had his semen analysis before Christmas and it's now looking like its going to be early March. To be honest, if we knew in early December that this was going to take so long, we would have just paid the £100 and had the analysis done privately. My GP has had everything she needed from me for the referral since November, but she can't send it off until his results are back.

We have no idea how long the waiting list is for referrals in our area so my fear is that when we do get his analysis results and my GP can refer us to the fertility clinic for further treatment, we'll have to wait months before we get an initial appointment.