GPs have an opportunity to help infertile couples say North-East scientists

A major study into infertility in the UK has found that GPs could save years of anguish and heartache for couples desperate to have children.

Experts from the universities of Sunderland, Durham and Newcastle, the NHS and the Newcastle Fertility centre at LIFE worked on the report.  'Epidemiology and Management of Infertility' is the first major epidemiological study into infertility management in the UK since 1990.

North-East researchers found that infertility treatment could be improved if GPs had a better understanding of infertility management options.

Dr Scott Wilkes, principal author of the report, says: "The problem is that GPs only see one or two infertile couples per year, so there is little opportunity to rehearse the skills necessary to manage the infertile couple".

The main findings of the report were:

• The incidence of infertility has remained unchanged over the last two decades at 0.9 couples per 1,000 total population.
• 36 per cent of all couples that went to their GPs achieved a pregnancy within one year and of the couples who successfully achieved pregnancy 75 per cent did so without treatment.
• Women are approaching their GPs at an older age but after a shorter duration of infertility than their peers in 1985.
• A significant proportion of couples were initially referred to secondary care fertility units that could not deliver the treatment they needed (e.g. IVF).
• The treatment end-point for half of all couples in the study was in-vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).

Dr Wilkes carried out the research while studying at the University of Sunderland. The report examined the experiences of almost 800 infertile couples in 58 GP practices in Northumberland and Tyne and Wear over an 18 month period.

Dr Wilkes says: "The incidence of infertility hasn't increased, but people's expectations are so much higher. Society has probably changed and we see more working women choosing to wait longer to have children and have a career, and so they are presenting later and requesting investigation and treatment earlier."

"Nationally, because there is no system of full evaluation for infertile couples in primary care, GPs do not have the opportunity to root out those couples who have fertility disorders such as sperm problems or blocked tubes, who require assisted reproduction in specialist IVF fertility centres.

"All initial investigations of infertility can now be carried out by some GPs in the North East.  Semen analysis, ovulatory blood tests and tubal assessment with open access hysterosalpingography (a radiologic procedure to investigate the shape of the uterine cavity and whether fallopian tubes are misshapen or blocked) are all available to GPs.

"If the couple are young, with no identified cause for their infertility, the best advice might be to wait. But just as important, the people who need specialist treatment can then be referred directly to an appropriate specialist unit."

The report also highlighted the current practice of excluding couples who had a child in a previous relationship but not their current relationship from treatment by some UK Primary Care Trusts.  If these couples were included then an additional 26 per cent of couples would become eligible for assisted reproduction.

Those involved in the research included former University of Sunderland primary care expert Professor Greg Rubin, (now at Durham University); Professor Alison Murdoch, IVF fertility expert based at Newcastle's International Centre for Life and epidemiological researcher Dr David Chinn from NHS Fife.

The report was first published in the journal 'Family Practice' in June 2009.