The role of primary care in infertility management.

Women frequently present to their general practitioner (GP) stating they have been trying for some time to get pregnant and failed. All GPs must be able to deal with the range of initial presentations in terms of history taking, examination and routine investigation. Treatment may be initiated in primary care, although at present most GPs are likely to refer to secondary care. In the future more GPs will undertake treatment themselves or refer to a GP with a special interest at Primary Care Trust (PCT) level. Both clomiphene and metformin either separately or together can be used in appropriate cases in primary care and are likely to lead to a high success rate and the prevention of unnecessary referrals to secondary care. GPs need to provide ongoing care throughout investigation and treatment for infertility and deal with subsequent outcomes both positive and negative. GPs as well as women themselves must be involved in the development of local guidelines from the outset together with secondary care specialists and those working on behalf of the PCT. It has yet to be shown that any guideline reduces NHS costs or improves patient outcomes.