Infertility/Recurrent Pregnancy Loss
Adult

Gynaecology

Useful Management Information

  • 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
  • Recurrent Pregnancy Loss (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 referral criteria?
Category 1 (appointment within 30 calendar days)
  • 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 regular unprotected intercourse)

If your patient does not meet the minimum referral criteria

  • Assessment and management information may be found on a range of conditions at 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

Essential Referral Information

  • History of:
    • previous pregnancies, STIs 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 +/- gonorrhea NAA
  • FBC, group and antibodies, rubella IgG, varicella IgG, syphilis 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)
  • Auto immune 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 cannot 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

  • Anti-mullerian hormone (AMH)
  • 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)
Last updated 15 November 2023

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Health Service District

Internal Referrals

Gynaecology (E-Blueslips)
Colposcopy (E-Blueslips)

Fax

(07) 5687 4497

Post

Booking and Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 559 083

Related HealthPathways

No directly related pathways found

Service Availability

Dr Graeme Walker
Medical Director Gynaecology

Facilities

Gold Coast University Hospital
Robina Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Gold Coast Health - For Clinicians
© The State of Queensland 1995-2021 | Queensland Government
Queensland Government acknowledges the Traditional Owners of the land and pays respect to Elders past, present and future.