Fertility NZ is a registered charity dedicated to providing information, support and advocacy to people experiencing fertility issues.

Questions for your GP

What a GP should cover

Questions about:
Lifestyle, especially alcohol, caffeine, drugs, exercise, weight gain or loss, smoking
Taking folic acid
Use of alternative or complementary medicine
Occupational exposure to potential hazards, especially heat for the man
Menstrual cycles
Fertility in any previous relationships
Previous surgery
Testicular injury
Possible Pelvic Inflammatory Disease (PID) or Sexual Transmitted Disease (STD)
General health
Investigations and checks
Up to date cervical smear
Rubella vaccination
Blood test for FSH, and possibly progesterone (the woman)
Semen analysis
Physical examination of both partners
Referral for tubal patency, by laparoscopy or hysterosalpingogram (HSG), depending on what else is found
Offer prompt referral to a fertility specialist if any of the following:
- Any abnormal or unusual findings from your medical history, examination or tests
- You have been trying for more than 12 months
- You have been trying for more than 6 months and you (the woman) is younger than 27 or older than 35
- Close members of your family having had menopause before the age of 40
- Two or more consecutive miscarriages
- You want action now

Types of referral which should be offered
Offer of public referral to a fertility clinic if you meet the eligibility criteria (the consultation is free, but you may need to wait)
(For this type of referral, the preliminary tests need to be finished. In some areas there are extra restrictions around the woman’s age and BMI that tie in with eligibility for publicly funded treatment)
Offer of private referral to fertility specialist or clinic (you pay for the consultation)
You can make an appointment with a fertility specialist without a GP referral at anytime.

 

For GPs – what to cover in a fertility consultation

Check:

  • Rubella status
  • Recent cervical smear
  • Medical history, including drug use and occupational exposure

Advise:

  • Woman to take folic acid
  • Stop smoking
  • Lose weight if BMI above 28
  • Gain weight if BMI below 19
  • Minimise caffeine and alcohol intake for both partners
  • Have intercourse every 2 days or so around the middle of the menstrual cycle

Investigate:

  • History around weight gain or loss if ovulation is irregular
  • Prolactin and thyroid function only if cycles are irregular
  • FSH and estradiol around day 2 of the menstrual cycle – estradiol needs to be below 300 pmol/l to correctly interpret basal FSH
  • Semen analysis, and repeat in 4-8 weeks if any aspect is below the reference range
  • Tubal patency unless very irregular or absent cycles or very poor semen quality – this is required for public referral in most areas

Refer to a fertility specialist
- Not pregnant after 12 months OR
- Not pregnant after 6 months if woman younger than 27 or older than 35, OR
- Family history of menopause before 40, OR
- More than 2 consecutive miscarriages, OR
- Genetic condition related to fertility, OR
- If any abnormal results from investigation, examination or medical history, including:
- Previous abdominal, pelvic or urogenital surgery on the woman or man
- Previous PID or STD
- Significant systemic illness

Our Green Prescription, popular with GPs, summarises how you can maximise your chances of conception.Green_script_p1.jpg