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Infertility/RPL

ADULT

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

 

  • Refer to HealthPathways and or local guidelines
  • Treatment is as a couple and requires a partner referral
  • 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 dietician
  • Infertility: Folic acid 0.5mg/day

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Reproductive counselling for fertility sparing options prior to cancer treatment including surgery and chemotherapy
    • 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)

1. Reason for request Indicate on the referral

  • 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

2. Essential referral information Referral will be returned without this

  • 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
  • Weight/ BMI
  • FBC group and antibodies rubella IgG varicella IgG, syphillis serology, HBV/HCV/HIV serology results
  • Day 21 serum progesterone level (7 days before the next expected period)
  • FSH, LH (Day 2-5), prolactin, TSH if cycle prolonged and/or irregular
  • STI screen result – endocervical swab or first catch urine for chlamydia +/- gonorrhoea NAA
  • Partner seminal analysis result
  • Pelvic USS (TVS preferable)
  • If  PCOS is suspected include the following:
    • SHBG results
    • Testosterone, DHEA-S results
    • Fasting blood glucose results
    • Lipids, TSH results
  • Include a referral with the following information for the partner
    • age and health, reproductive history, testicular conditions, seminal analysis result

3. Additional referral information Useful for processing the referral

  • 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)

4. Request

Patient's Demographic Details

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

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
  • Body Mass Index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

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

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

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.)
  • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.
  • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.