Subfertility: how did you get a referral?

[LunarSea]

A few quick questions for those who've had referrals/treatment for subfertility (particularly secondary subfertility when you'd already had one child and/or conceived previously).

How long did it take you to get a referral?
How long did you have to be trying without success first?
And what was the attitude of your GP's towards it?

I initally discussed investigation with GP after not conceiving (#1) for about 15 months - told it would have to be 2 years before they'd do anything. Finally conceived after 18 months, but m/c at 6 weeks.

Then took 30 months to conceive ds (now 3 3/4) - but in between times told that as I had conceived in the past there was "obviously no problem", so it was now 3 years before they'd look into it.

Since then 32 months ttc #2, resulting in m/c at 11 weeks - am now told that having conceived 3 times there will not be any referal, ever.

GP kept quoting statistics that even with perfectly normal fertility only 85% would conceive in 18 months, so it's "probably just totally random and down to bad luck". Am so annoyed about that, since I know enough about statistics to be well aware that the probabilty of being in that 15% who don't 3 times in a row is only 9 in 8000 (or 0.1125%). And that's without considering that for us 2 out of three times have been significantly longer than 18 months, and that I'd done all I could by way of opk's and charting to swing the odds in our favour. So even that probability is probably an overestimate. Actually the figures here do seem to suggest it's less than that given that 2 out of 3 have taken over 2 years.

I'd have thought that those odds are a pretty good indicator that just perhaps we're not in that "perfectly normal fertility" population he's assuming. Yet there seems to be nothing I can do or say to persuade him otherwise.

I'm pretty sure that at least part of the problem is down to having very irregular cycles - mostly short (as low as 15 days, typically only about 22) but about one in six 40+ days. All he was prepared to suggest for that was the pill (grrr). Not helpful in the circumstances. No suggestion that there might be some underlying cause for it, or anything that could be done about it - yet I'm sure I remember people posting here who've had treatment related to luteul phase defects and the like.

And he even suggested that there wasn't any point in testing dh because, even if sperm counts are low, there's nothing that can be done about it. Now I know from things that have posted on mumsnet before that there's good evidence that zinc supplements can help so he's definately wrong on that. (As it happens I've got dh taking them anyway, but GP didn't know that).

I'm just so angry/frustrated at this, as it seems that not only are they being unhelpful, but the length of time we've had to fail seems to be double what it is elsewhere - I keep reading that people are getting referrals after just one year of not conceiving.

I don't really know where to go now - any suggestions? Or if anyone has any other statistics, references, etc which might help the argument I'd be grateful for those too.

Don't know whether this will help but

when we had difficulties conceiving we were told by Dr that they couldn't do anything about it cos we had a child

I had a friend at a local hospital who got me in touch with the assisted conception unit manager who told me that was ridiculous .. fine the NHS couldn't fund IVF but they could do all the initial tests to check what was happening

went back to dr and told him what to write on referral letter and who to direct it to

turns out I had a short post-luteal phase (your hormones after pregnancy settle back any which way and whilst I'd had no problems conceiving DS I would never have conceived again without doing something about it) .. they gave me clomid (about 70p a packet) and I conceived DD first cycle

so my advice would be DO NOT GIVE UP and GET STROPPY AND DETERMINED

totally agree with Twiglett get stroppy I went to see docs after trying for 6 months for second and was refered to specialists... had some tests which showed some issues and at that point I went private as my hormones would not allow me to wait for appointment got DD on second treatment... I was over 30 but friend who is 28 has just been to see specialist but only after she put lot of pressure on doc... we both had secondary infertility and I don;t think NHS see it is a priority at all -- you need to push for what is your right to tests etc

different to the thread but I was looking to be an egg donor to help couples that couldnt concieve. I had contacted our local fertility clinic who said they would et back to me, i called them around 6-8 more times and still nothing was done. I found this awful as I wanted to help someone with the most prcious gift in life-children, and these people simply couldnt be arsed to call me back.

I enquired soon after having my twins(who are now 17 months) but now I am unable to donate as I had to have a hysterectomy, a waste of eggs really and some lady could have had them

we're currently going through this lunar. We have one DS and have been ttc #2 for over a year. GP have been ok about it actually and happily referred us for tests after 10 months, we've actually decided to go private because the waiting list for the diagnostic tests is 4 months and if we do have to have treatment we'd have to go private anyway as we already have one.

Your GP sounds like he doesn't know what he's talking about. If it is a sperm problem there are procedures that can help your chances. Can you see another GP?

lunar, I only had to wait 6 months b4 I was referred for a gyno apt, then had to wait 6 months to actually see the gyno, I've had one prev M/C, but have had other hormone problems from a child. and only one overy, initially my Dr seemed a bit reluctant to do anything so I did push to go on the waiting list at least. but he seemed to pick up a bit once i'd had two completely different blood tests showing my hormones.

My other friend on the other hand was told by two different Dr's she'd had to try for at least a year b4 they would even think about refering her, (she went to 3 male dr's who told her this) then she saw a female one after 6 months who refered her straight away. my advise get a second opnion.

Your GP seems extremely unsympathetic. how ridiculous not even to agree to basic tests like sperm count. Have you tried all the others in the practice? What about moving practices?
Or, how about phoning your local fertility specialists directly and finding out how you can get a referral?
Or, what about getting a private consultation - an initial consultation will be around £200 I would think - then once you are 'in the system' you may find taht you can have investigations on the NHS. It is true though that you won't get treatment on the NHS since you already have a child.

When I was ttc number 1, I had basic tests done at my GP after about 10 months and was referred so that I could be seen by one years' ttc. Obviously for no 2 I was referred straight away since I'd never had a spontaneous conception.

LunarSea,

Would agree with Elliott's counsel to seek out a second opinion from one of the sources suggested.

You can and should be investigated further to determine the nature of the problem. Both of you should be tested in tandem, male factor subfertility needs to be either confirmed or ruled out.

The underlying causes behind your irregular cycles (I was hazard a guess here and say that hormonal imbalances are responsible) need to be checked out thoroughly. You have been fobbed off to date.

Zinc supplements and the like will do no harm at all but would say that generally speaking many drugs have been tried to improve such counts without much success. Count is not the only factor involved, motility is as well. Sperms are complicated things and there is much about sperm and sperm production that is not yet fully understood.

I wish you well

agree with eliott- would go private and pay for a consultation . this is what we did in the end as GP was useless. at least this way you will not have to wait any more time and will have the answers you need.

I started charting after about 6 months of ttc because cycles really erratic - from 28 to 60 days (already have ds). Went to see GP after one month of charting and told her what I'd been doing (she didn't ask for evidence) and she immediately offered to refer me - although this was probably because my charting was indicating that I wasn't ovulating. Anyway NHS waiting list was long so we went private for initial consultation (about £250) but have been treated by same Consultant on the NHS since then (got PCOS btw). I would recommend pushing GP for referral - or at least to get initial bloods done (which GP can arrange) just to give you an idea if its a hormonal thing, otherwise go private if you can. Good luck.

My GP would have referred me after 6 months, given my age (44). As it was I only went to see him after 12 months and he was happy to refer me - but first of all did some blood tests to check the basics - was I ovulating, whether I was anaemic etc.

He was even prepared to start the process just before ds was conceived, as we had been trying about 6 months then (but as I have a short cycle, that was actually 8 cycles). He only got as far as checking I was ovulating - but then my period never came and the result is ds (4.5)

I also had a miscarriage 2 years ago, and a termination 20+ years ago, so I know I used to be able to conceive - but your body changes.

The hospital appointment came through quite quickly - I think only a couple of months later (that was after taking about 4 weeks to send me a letter saying that the probable wating time for an oppintment was 17 weeks - but one came through about 4 weeks later).

The consultant also talked about other options such as IUI (I think), where the sperm is "washed" and then inserted directly into the uterus, thus avoiding some of the "hostile" bodily fluids. But for the moment, as I am still ovulating (although not neceassarily every cycle) he just has me on Clomid to "improve the quality of my eggs".

Your GP does sound very negative. I like the idea of contacting your local hospital and asking what they would expect the normal criteria for referral to be, and then you can back to him armed with that info. Has he even checked your blood to see if you are ovulating?

Failing that, change GPs.

actually, the more I think about it the more unreasonable this GP seems, in both refusing to do simple tests and also effectively blocking your path to a second opinion. OK, so the waters are slightly muddy in that you have had spontaneous conceptions, but the fact is that in five years of ttc you have had two miscarriages and one pregnancy - I think that seems completely reasonable grounds for further investigation, quite apart from the fact that they are supposed to respond to patients' own concerns.
I think you should be kicking up a much bigger fuss over this. I'll try to find a link to any referral guidelines if I can.

I had a GP who talked about how much my ivf treatment was going to cost the tax payer and his practice. (went home feeling guilty and distraught)My husband reported him and we moved practice. There are some right so an so's out there. Maybe its time for a GP move.

Message withdrawn

and don't forget that a GP is just that: a General practitioner and they are not, by any stretch of the imagination, an expert on all things medical.

Thanks all - he really made out that I had unrealistic expectations, so it's nice to know that someone out there agrees with me at least.

elliott did you ever manage to find those referral guidelines?

Had to see the GP again today, and he came up with yet more spurious statistics which make Roy Meadow's grasp of the subject look positively sophisticated.

He kept saying that getting pregnant 3 times in nearly 9 years is a really high rate of fertility and that if everyone was that fertile there would be lots of women with 10 kids around. And that 3 conceptions is more than most people get in a lifetime, and the average woman has less than 2 children so only having one is perfectly normal and I should be really pleased.

He must think I've got an IQ of about 2 if he expects me to fall for that. You'd think if he's a GP he'd know that the reason most people don't have 10 kids is more to do with contraception than fertility rates. And that the average reproductive rate is influenced by those who choose to have no children.

Feel like I'm just banging my head against a brick wall at the moment.

I have been TTC for #2 for 12 months just about. DD is now 3y 3m. She took 30 months of TTC (with an early mc after the first 15 months; another 15 months again afterwards).

I spoke to the nurse at the clinic this wek - there for other reason. She advised me that as I am over 30, that I should go and speak to the GP.I asked about the fact that I know that it is possible for me to get pg - been sp twice. But she said that as I have a history of it taking a long time - longer than average - it is worth talking to him and seeing about some basic checks.

I have an appointment on Friday, and I am scared half to death.

Hula - I've just answered my own question about referal guidelines I think - they're here . Long documents, and I haven't read them all yet, but it certainly looks as if the 2 years (having never conceived) and 3 years (after 1 m/c) I was told are NOT in accordance to the recommendations, and nor is the total dismissal of any test for dh. And the recomendations don't actually seem to say anything about the case being different if you've already had a pregnancy and/or a child. Unfortunately they're a bit unspecific about my situation post m/c, but with a history of trouble conceiving (even if I could have had a referal earlier if they'd followed the guidelines), so I can't easily confront him with them at this stage.

Is it possible to see a different GP? I really wouldn't waste any more time with this one if you can help it.

I'm really at his attitude. It makes me realise just how lucky I was - I went to see my GP when I hadn't had a period 5 months after stopping the pill and he referred me straight to a gynaecologist (NHS) who confirmed the GP's suspected diagnosis of PCOS - fortunately it was treatable and I conceived after a couple of months of medication.

I suppose it helped that my GP had a specific diagnosis in mind, but it's incredibly arrogant (or indecisive? not sure which) of yiours not to refer you to a specialist.

See another GP
We had seconary infertility and after trying to conceive for 10 mths we got pg but it ended in MC. After 4 more mths we went to GP and he was great, said DH should be tested first and then sent us to Cons gynecologist who did blood tests on both me and DH. He then put me on clomid which worked on 2nd cycle. PLEASE see a different Dr... yours sounds a complete d*"k h&%d and I am sure they can't all be like that. Good luck

We were referred by our GP after ttc for 9 months as we are both over 35. Turns out we both had fertility problems. Took us 2.5 years to get a BFP, during which time we both had acupuncture, ate only organic food, dh took zinc, vit C and chinese herbs. The only choice given to us by traditional medicine was IVF/ICSI but we managed to get there on our own! Sorry, a bit off the point, but we wanted to do everything we could to help ourselves. I'm so surprised your GP told you there was nothing that could be done about your DH's sperm count - how incredibly unhelpful! My hormone levels were low when first tested, but after 3 months of acupuncture were back up to normal when re-tested.

Found this thread very interesting as I am suffering from secondary infertility too. DD was conceived on first cycle, but we have now been ttc no. 2 for 10 cycles. I started temping & using opks a few months ago & realised I have a very short luteal phase (7 to 8 days). Reading up on this, there seems to be zero chance I'll conceive without help . So went to see doctor last month.....she was completely useless, told me temping & opks were a waste of time & inaccurate & just make you more anxious & therefore less likely to conceive. But in my mind, they've diagnosed what is wrong with my cycles which must be a good starting point. She rubbished the idea that I couldn't get pregnant due to such a short LP. She also said that as I'd already had a child I won't have problems having another. Obviously untrue.....I remember reading recently that secondary infertility is now more common than primary infertility. So, where do I go from here? I've booked to see a different doc next week, but meanwhile time is ticking on, I'm mid-30's & we want at least 2 more children. Also, the age gap will now be at least 5 years which isn't ideal. Apparently progesterone tables/injections are used to treat a short LP, so Twiglett, I'm very interested that you were prescribed clomid. I've also found many american websites where you can buy both clomid & progesterone tablets........ obviously I don't won't to do this but I'm getting pretty desperate & not quite sure what to do if I don't get any joy out of the doctor next week. What should I do? Break down & demand treatment? I can't really afford private treatment right now. How did everyone else manage to get their doctor to take them seriously?
Thanks and sorry for the ramble......Iona x

Iona just seen this

you are right and your GP is wrong .. horribly wrong

My consultant said that she gave me clomid to kick-start my hormones again .. you need to have a post-luteal phase of at least 10 days for any fertilised egg to be able to establish itself

She did mention that progesterone was also used by other consultants but that she personally did not have any faith in it (she explained why but can't remember) but I have read of other successes with short post-luteal phase and progesterone treatment and its worth a shot

please don't self-medicate with drugs like clomid

if you want / have time to try a natural alternative then high dosage Vitamin B6 is supposed to be helpful (100mg to 200mg) but that takes months

think you should find a better GP to be honest

good luck

Hi Twiglett, thanks for the reply. I've tried the b6 (thought it had started working last month when LP went up to 10 days but it was just a one off), also agnus castus & sunflower seeds so really am pinning all my hopes on this second doctor. I think I will have to create a scene . Unfortunately I can't even see my usual doctor coz she's on maternity leave......typical! Glad the treatment worked for you.... nice to hear of a success story. Fingers crossed for Tuesday. Iona x

ionaming - I've been TTC no 2 for 15 months (conceived DS on first cycle). I tried Persona OPKs but never really got a result so have had tests and so has DH and I'm now on first cycle of Clomid (bit scared about that actually but hoping it works). You definitely need to see a new GP. We decided to scrape the money together to get the tests etc done privately as waiting list was so long on NHS to see consultant and ultimately if we have to have any treatment we can't have it done on the NHS anyway because we already have a child.

Age gap for us will be minimum 5 years which I worry about a fair bit, it's very odd isn't it? to have conceieved one child easily and then be in this position.

good luck