Infertility/RPL

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Useful Management Information

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
Recurrent Pregnancy Loss: 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

Category 1	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	Category 2 referral for infertility not accepted, refer to a private specialist to avoid delay
Category 3	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 doesn't meet the minimum referral criteria 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

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

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

Essential Referral Information (for Infertility and RPL)

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
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
Anti-mullerian hormone (AMH)
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

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)

Send Referrals To

Smart Referrals

Coming Soon

Internal Referrals

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

Fax

5687 4497

Post

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

Enquiries

1300 559 083

Service Availability

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.