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Infertility / RPL

Find assessment and management information at Brisbane South HealthPathways under:

Useful management information

  • Refer to HealthPathways and or local guidelines
  • Treatment is as a couple and requires a partner referral
  • Mature age referrals (>38yo) direct referral to private so as not to waste reproductive time
  • IVF not available in public hospitals
  • To assess tubal patency, consider Hysterosalpingography (HSG) or saline infusion USS (sonohysterography) if history suggestive of blocked fallopian tubes
  • Seminal analysis of partner (≥4 days of abstinence). Repeat in 4-6 weeks if abnormal
  • Lifestyle modification (increased activity, dietary, weight, smoking, alcohol)
    • Simple moderate physical activity including structured exercise (at least 30 minutes/day) and optimising incidental exercise assists with weight loss and weight maintenance
    • Achieve optimal weight BMI 20 – 30
    • Referral to dietitian
  • Infertility: Folic acid 0.5mg/day
  • RPL: Definition ≥ Three (3) CONSECUTIVE miscarriages (excluding chemical miscarriages) as documented by ultrasonography or histopathologic examination.  Second trimester miscarriages are considered more significant. Two (2) would be an indication for further investigation.

Minimum referral criteria (Does your patient meet the minimum criteria?)

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)

If you feel your patient meets Category 1 criteria, please mark "urgent" on your referral

  • Reproductive counselling for fertility sparing options prior to chemotherapy treatment
  • All other Category 1 referral for infertility are not accepted, refer to a private specialist to avoid delay
Category 2
(appointment within 90 calendar days)
  • Category 2 referral for infertility not accepted, refer to a private specialist to avoid delay
Category 3
(appointment within 365 calendar days)
  • All referrals for infertility for example but not limited to:
    • Surgical management of hydrosalpinx
    • Anovulation for ovulation induction (selected cases)
    • Unexplained infertility (selected cases)
    • Recurrent pregnancy loss

(Definition: Infertility is the failure to achieve pregnancy after 12 months or more of unprotected intercourse)

If your patient does not meet the minimum referral criteria

  • Assessment and management information can be found on a range of conditions at Brisbane South HealthPathways
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Standard referral information (To be included in all referrals)

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • A comprehensive capture of information in relation to MSH Referral Criteria

Clinical modifiers

  • The presence of clinical modifiers may impact the categorisation of the patient.
  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

 

Essential referral information for Infertility / RPL referrals (Referral will be returned without this)

Essential Referral Information (for Infertility and RPL)

  • History of:
    • previous pregnancies, STDs and PID, surgery, endometriosis
    • other medical conditions
  • Include the following information about partner
    • age and health, reproductive history, testicular conditions, semen analysis
    • a referral letter for the partner is required
  • Weight/ BMI
  • STI screen result – endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA
  • FBC group and antibodies rubella IgG varicella IgG, syphillis serology, HBV/HCV/HIV serology results
  • FSH, LH (Day 2-5), prolactin, TSH if cycle prolonged and/or irregular
  • Pelvic USS (TVS preferable)
  • If PCOS is suspected include the following: 
    • Free androgen index (FAI) or Free Testosterone
    • Fasting blood glucose result
    • Lipids, TSH results


Infertility – additional Essential Referral Information

  • Day 21 serum progesterone level (7 days before the next expected period)


First trimester RPL – additional Essential Referral Information

  • Thrombophilia screen, antiphospholipid syndrome  (APS)
  • Autoimmune screen 
    • Coeliac serology – serum deamidated gliadin peptide (DGP), tTG Ab
    • Antinuclear antibodies (ANA) only if personal or family history indicates higher risk of autoimmune disease
  • Karyotype for both parents


Second trimester RPL – additional Essential Referral Information

  • Hysterosalpingogram (HSG) or hystero-sonogram
  • US with cervical length

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional referral information for Infertility / RPL referrals

  • BMI
  • History of marijuana use (including partner)
  • Fasting blood glucose, testosterone and free androgen index test for those likely to have PCOS
  • Hysterosalpingography (HSG) or saline infusion USS (sonohysterography)

Emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • Ectopic pregnancy
  • Ruptured haemorrhagic ovarian cyst
  • Torsion of uterine appendages (ovarian)
  • Acute/severe pelvic pain
  • Significant or uncontrolled vaginal bleeding
  • Severe infection
  • Abscess intra pelvis or PID
  • Bartholin’s abscess / acute painful enlargement of a Bartholin’s gland/cyst
  • Acute trauma including vulva/vaginal lacerations, haematoma and/or penetrating injuries
  • Post-operative complications within 6 weeks including wound infection, wound breakdown, vaginal bleeding/discharge, retained products of conception post-op, abdominal pain
  • Urinary retention
  • Acute urinary obstruction
  • Unstable molar pregnancy
  • Inevitable and / or incomplete abortion
  • Hyperemesis gravidarum
  • Ascites, secondary to known underlying gynaecological oncology

Out of catchment

Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Last updated 18 December 2023