How long before seeking advice?

[Thunderdo]

Hi. My husband and I have been TTC for two years. We are both 34. We went to see our GP recently but were told that as there was no obvious contributing factors, we should come back in another year.

My local fertility clinic website says it has a 10mth+ waiting time from being referred by a GP, so I'm starting to get anxious that if there is a problem I will be 36 by the time I see anyone.

Is three years the norm before other things are considered? Looking online, it doesn't seem to be!

I was always told a year before seeing your GP, but that you likely won’t be on any treatment plan for another year. So two in total.
I am now 27, we went to the GP after 6 months due to other health issues and started clomid (after a lot of testing) about 10 months after our initial GP appointment!

NICE guideline suggest you should already be being referred so please return to see (a different?) GP.

I was referred after 1 year or trying to conceive. After 2 years, I would certainly expect the GP to refer you to a local clinic and I’m certain if they were following the NICE guidlines you should be referred. Can you see another GP?

No that’s not normal IME. We went to GP after 1 year of TTC. In the following year we had:

Day 21 blood test
Sperm analysis
Referral to fertility clinic
Fertility clinic appointment & TV ultrasound
Hycosy
Referral for laparoscopy.

With roughly 2-3 months between each thing. Laparoscopy was in January. Now we’re at 2 years TTC next step is to go on the ivf waiting list (6 month wait once on it).

Standard position I have always heard is that you should start getting fertility investigations after 1 year if under 35 and 6 months if over 35.

Nhs website says If you have been trying for a baby for 1 to 2 years without success, see your GP for advice. www.nhs.uk/common-health-questions/pregnancy/how-long-does-it-usually-take-to-get-pregnant/

If I were you I’d go back to GP. When they say there are no obvious contributing factors, have they done any tests to ascertain that?

I was told 80% of couples conceive within a year, 90% within 18 months so if you haven’t conceived within two years of TTC (assuming there’s no hidden thing like one of you has been working abroad for half of that!) you should be having investigations.
Our GP was lovely when we went after a year and said given the stats, half of couples who were referred after a year conceived naturally whilst on the waiting list (we weren’t one of them!). I remember when we were referred after a year we had a ?subfertility label, after 18 months the ? was dropped. I’d see a different GP. Get the info for details about how referrals work, you absolutely should be referred, especially given the waiting list times.

www.nhs.uk/conditions/infertility/diagnosis/

“See your GP if you haven't conceived after a year of trying.
You should see your GP sooner if you:
are a woman aged 36 or over – the decline in fertility speeds up when a woman reaches her mid-30s
have any reason to be concerned about your fertility – for example, if you've had treatment for cancer or you think you might have had a sexually transmitted infection (STI)
Fertility tests can take time and female fertility decreases with age, so it's best to make an appointment early on.
Your GP will be able to carry out an initial assessment to check things that may be causing your fertility problems and advise you about what to do next.
It's always best for both partners to visit their GP as fertility problems can affect a man or a woman, or sometimes both.“

Well, she did a blood test for me and a semen test for my husband and just said everything looked fine so to carry on. It's so frustrating because there doesn't seem to be anyone else you can contact for advice.

We went to the doctors after nearly 2 years of trying. I am now pregnant via IVF and by the time I give birth it will have been 3.5 years since we started trying. I would be pushing to be referred as even once the ball starts rolling things take a while.

I'd go to see a different GP

Can you try phoning the local assisted conception service and ask what the criteria for referral from the GP are?

The guidelines are quite clear

www.nice.org.uk/guidance/cg156/chapter/Recommendations#initial-advice-to-people-concerned-about-delays-in-conception

Go back to see GP and request referral... Good luck!

You need additional tests like an ultrasound to see if there’s issues such as polycystic ovaries and a HSG to check there’s no bloackages in your tubes. Don’t be fobbed off.

Well this is what I'm struggling with - we don't seem to have any way of contacting the conception service directly. I can't find a phone number or email.

"The Fertility Clinic is situated in the Women's and Children's Outpatients Department at Noble's Hospital." www.gov.im/categories/health-and-wellbeing/clinics-and-hospital-outpatients/women-and-childrens-clinics/gynaecology-womens-health/fertility-services/

Would it be weird if I just turned up at the clinic and asked? :-s

Due to the way funding works, they will not be able to see you without a GP referral - you just need to go back and request a referral and if necessary quote NICE guidelines

The OP seems to be based on the Isle of Man so the guidelines may be different there?

In any case, OP, you need to go back to your GP, ask for a referral, and don't take no for an answer. You're already in the 10% of people who haven't conceived after 2 years so they can't reasonably expect you to wait any longer without more detailed investigations.

Under 35 the wait time is 1 year and over 35 it's 6 months of trying to conceive before referral but then the actual process of even getting to the point of starting injections etc can take up to 12 months on the NHS. (This was in 2014 in the West Midlands).
As we now have a child we have gone private this time and the wait time was......2 weeks! 🤣