All information is correct at time of printing and is subject to change without notice. The Devon Formulary and Referral Website is not in any way liable for the accuracy of any information printed and stored by users. For the most up-to-date information, please refer to the website.
Please note pre-referral criteria have been agreed across Devon and are applicable to this referral.
Referrals will be returned if the proforma has not been completed with the following results which must have been taken within the last 12 months:
For same sex couples please complete the appropriate part of the proforma.
If patient has previously had IVF treatment please include how many cycles and if privately and/or NHS funded in the referral letter.
It's important to identify those couples who may benefit from early referral- see assessment below:
Couples experiencing delay in getting pregnant are likely to be anxious and stressed and may need extra support.
The following groups of patients are not entitled to initial consultation, investigation or treatment according to the NEW Devon and South Devon and Torbay Assisted Conception Commissioning Policy:
All other patients are entitled to initial consultation if they meet criteria for referral outlined below but will only be offered NHS treatment if eligible according to the NHS Devon Commissioning Policy: Assisted Conception
Same sex couples are eligible for consultation with a fertility specialist for advice and to discuss the options available to them, prior to commencing artificial insemination. Please be aware that the commissioning policy requires that the couple are demonstrably sub-fertile before investigation or possible treatment can be offered. For female same-sex couples, failure to conceive after six (6) privately funded cycles of artificial insemination within the past 12 months, in the absence of any known cause of infertility, should be the indication for NHS funded fertility investigations.
For male same-sex couples, failure to conceive after six (6) privately funded cycles of artificial insemination within the past 12 months or 12 months with vaginal intercourse, in the absence of any known cause of infertility, should be the indication for NHS funded fertility investigations.
Please note there are separate eligibility criteria for assisted reproduction techniques (including IUI, IVF, ICSI and donor insemination) (page 5 of policy). However, in patients who are undergoing investigations for infertility, who do not meet the criteria for NHS funded assisted reproduction techniques (ART), if subsequent investigation demonstrates the need for ART, then this will need to be self-funded. It may be useful to make patients aware of this prior to referral.
Prior to referral patients must have been trying to conceive for at least 12 months, except where a woman is 36 years or over when earlier referral can be offered (local specialist advice is that 6 months is a reasonable period of time)
However in the following instances early referral is recommended if there is a known cause for infertility:
Take history to exclude "red flags"
Ask if woman has had 2 MMR vaccinations. Recommend vaccination if not/not sure. Advise secure contraception for 1 month after vaccination.
(Rubella testing is no longer recommended)
Opportunistic review of medical co-morbidities, drugs and uptake of cervical screening services.
Early referral is recommended if there is a known cause for infertility e.g.
If no red flags and have been trying to conceive for a minimum of 12 months then perform base line investigations to exclude red flag diagnoses which can't be detected on history:
Semen analysis x 1 - if first result abnormal repeat after 6 weeks
Semen samples require direct submission to:
Fertility Exeter,
Royal Devon & Exeter Heavitree Hospital,
Gladstone Road,
Exeter,
EX1 2ED.
Tel: 01392 405115.
Patient information here.
NB: It is vital that that the semen is collected and transported to the laboratory in the correct way. Otherwise the result will be affected. The recommended technique is available here .
Initial investigations prior to referral for fertility treatment form
If history and investigations reveal no problems then advise couple about:
Couples where no cause for subfertility has been suggested from history and basic investigations have a good chance of spontaneous pregnancy. They should be advised to continue trying with regular intercourse for another year to avoid the risk of multiple pregnancy from fertility treatment.
If any "red flags" have been identified on history or investigation, please refer to secondary care.
Please note pre-referral criteria have been agreed across Devon and are applicable to this referral.
Referrals will be returned if the proforma has not been completed with the following results which must have been taken within the last 12 months:
For same sex couples please complete the appropriate part of the proforma.
If patient has previously had IVF treatment please include how many cycles and if privately and/or NHS funded in the referral letter.
BMI for male is helpful but not mandatory, and smoking status for both partners is also helpful. (There is a link between abnormal BMI, positive smoking status and infertility).
Please note eligibility criteria on page 5/6 of the policy regarding NHS Funded Assisted Reproduction Techniques; it may be beneficial to discuss these criteria prior to referral to help manage patient expectations.
Refer via DRSS on e-Referral
Initial investigations prior to referral for fertility treatment form
Arrangement for patient semen samples
This guideline has been signed off by NHS Devon
Publication date: January 2019
Updated: September 2020