CHAPTER 3 - Infertility

Summary

Key points

1. ✓ All patients with infertility problems should have prompt access to an integrated multidisciplinary service that provides efficient and accurate assessment of their clinical situation.

2. ✓ Care should be individualised to meet the particular needs of those seeking help.

3. ✓ Care should be reinforced by access to adequate information and appropriate counselling services.

4. ✓ Patients should be supported in making informed choices about their care.

5. ✓ The 18-week referral-to-treatment pathway is an opportunity for commissioners and providers to work together to improve services.

6. ✓ The involvement of general practitioners in initial investigation is integral to achieving the 18-week target.

7. ✓ Patients should receive consistent advice in primary, secondary and tertiary settings.

8. ✓ Multiple pregnancies are a major issue of concern and, if the problem is to be adequately addressed, commissioners and providers need to work together in formulating contracts which include the use of cryopreserved embryos in the definition of a treatment cycle.

9. ✓ Gamete donation and preimplantation genetic diagnosis services need to be considered in the context of a national service framework.

10. ✓ Delivery of high-quality specialist services demands availability of personnel with special skills. All staff should have access to training to meet their needs.

11. ✓ The numbers of subspecialists and special interest consultants are presently inadequate to meet service requirements.

12. ✓ A rolling audit programme should be in place at all stages in the pathway of care for patients and should regularly assess clinic and laboratory standards.

13. ✓ Engagement in research should be encouraged in all settings and specialist and subspecialist centres should engage with national trials initiatives.

Introduction

Fertility problems affect as many as one in seven couples in the UK. A common definition employed in describing infertility is the inability of a couple to conceive following 12–24 months of exposure to pregnancy. About 85% of couples having regular unprotected intercourse will have achieved conception by the time 1 year has elapsed and, by 2 years, this figure will have reached 92%.