When to See a GP About Fertility: UK Referral Pathways

Medically reviewed content. Last updated: April 2026.

Knowing when to seek help can feel unclear when you are trying to conceive. Should you wait a full year? Should you go sooner if something feels wrong? This guide explains the NHS referral pathway for fertility, what happens at your first appointment, and how the system works in the UK.

When should you see your GP?

NICE guideline CG156 provides clear thresholds.

The standard timeline

If you are under 36 and have been having regular unprotected sex for 12 months without conceiving, see your GP. Regular means every two to three days throughout your cycle, not limited to specific days.

If you are 36 or older, see your GP after just 6 months. This earlier threshold exists because age-related fertility decline means that timely investigation and treatment can make a meaningful difference.

See your GP sooner if...

Regardless of how long you have been trying, you should see your GP straight away if:

• Your periods are very irregular, very heavy, very painful, or have stopped altogether
• You have a known condition that can affect fertility, such as endometriosis, PCOS, or a thyroid disorder
• You or your partner have had previous cancer treatment (chemotherapy or radiotherapy)
• Your partner has known issues with erections or ejaculation
• You or your partner have had a sexually transmitted infection that may have caused damage (such as chlamydia or gonorrhoea)
• You have had previous pelvic surgery or ectopic pregnancy
• Your partner has had undescended testicles, groin surgery, or known testicular problems
• You are concerned about your fertility for any other reason

There is no harm in being seen early. Your GP would rather you came in with a question than waited unnecessarily.

What happens at the GP appointment?

Your GP will take a detailed history from both partners. Be prepared to discuss:

• How long you have been trying
• How often you have sex
• Your menstrual cycle (length, regularity, any changes)
• Any medical conditions, medications, or previous surgeries
• Lifestyle factors: smoking, alcohol, weight, exercise
• Any previous pregnancies (for either partner, including with other partners)
• Family history of fertility problems or genetic conditions

Initial investigations

Your GP can arrange several first-line tests without needing to refer you to a specialist.

For the person with a uterus:

• Day 21 progesterone blood test (or 7 days before your expected period if your cycle is not 28 days). A raised progesterone level confirms that you ovulated that cycle. If the result is low, the test may be repeated in a subsequent cycle.
• Hormone profile. Blood tests for FSH, LH, oestradiol, prolactin, and thyroid function. These are usually done on day 2 to 5 of your cycle and help identify hormonal causes of irregular ovulation.
• Rubella immunity check. To confirm you are protected before pregnancy.
• Chlamydia screening. Untreated chlamydia can cause tubal damage.
• General health bloods. Full blood count, ferritin, vitamin D, and HbA1c may be checked.

For the partner with testes:

• Semen analysis. This is the standard first test. Your GP will arrange for a sample to be provided (usually at a hospital or clinic laboratory). Two samples taken at least three months apart are recommended for a reliable result. The test assesses count, motility, morphology, and volume.

These initial investigations can usually be completed within one to two months.

What happens next?

If initial tests are normal

If all basic tests come back normal, your GP may suggest continuing to try naturally for a further period, particularly if you are younger. They may also offer a referral to a fertility clinic for more detailed investigation, including tubal patency testing (to check whether the fallopian tubes are open).

If tests show a problem

Depending on what the tests reveal, your GP may:

• Refer you directly to a fertility specialist (reproductive medicine consultant)
• Treat a specific issue in primary care (for example, prescribing thyroid medication if thyroid function is abnormal)
• Arrange additional investigations before referral (for example, a pelvic ultrasound to look at the ovaries and uterus)

The referral to secondary care

NICE recommends that couples should be referred to a specialist fertility service if they have not conceived after appropriate initial investigation and one year of trying, or earlier if there is a known cause of infertility.

In practice, referral timelines depend on your local Integrated Care Board's criteria. Some areas refer after 12 months, others after 18 months or 2 years. Your GP can tell you the specific pathway in your area.

What happens at the fertility clinic?

Once referred, you will usually be seen at a hospital-based fertility unit or a dedicated reproductive medicine clinic. Appointments typically include:

Tubal patency test

This checks whether the fallopian tubes are open. Options include:

• Hysterosalpingography (HSG). A dye is injected through the cervix and X-rays are taken to see if it flows through the tubes. It can be uncomfortable but is usually quick.
• HyCoSy (hystero-contrast sonography). Similar to HSG but uses ultrasound instead of X-ray.
• Laparoscopy and dye test. A surgical procedure under general anaesthetic where a camera is inserted through a small incision in the abdomen. Dye is passed through the tubes to check for blockages. This also allows the surgeon to check for and treat endometriosis or adhesions.

AMH testing

Anti-Mullerian hormone (AMH) is a blood test that gives an indication of your ovarian reserve (how many eggs you have remaining). It is often done at the fertility clinic rather than by the GP. Important: AMH tells you about quantity, not quality, and a low AMH does not mean you cannot conceive naturally.

Further semen analysis

If the initial semen analysis was borderline, a repeat test or more detailed analysis may be carried out. In some cases, the partner may be referred to a urologist.

Discussion of treatment options

Based on all the investigation results, your consultant will discuss the most appropriate treatment pathway, which may include ovulation induction, IUI, IVF, or other approaches depending on your diagnosis.

How long does the whole process take?

Timelines vary, but a typical pathway might look like:

• Months 1 to 12 (or 6 if over 36): Trying naturally
• Month 12 to 14: GP appointment and initial investigations
• Month 14 to 18: Waiting for specialist referral and first clinic appointment
• Month 18 to 24: Specialist investigations and start of treatment

Some areas have longer waiting lists for NHS fertility services. If you are concerned about delays, ask your GP about the expected wait time and consider whether a private initial consultation (usually £200 to £350) might help speed up the diagnostic phase.

What can you do while waiting?

• Continue having regular sex every two to three days
• Take folic acid (400mcg daily) and vitamin D (10mcg daily)
• Optimise your lifestyle: healthy eating, regular exercise, stop smoking, reduce alcohol
• Track your cycles so you can share useful data with your specialist
• Look after your mental health. Waiting for answers is stressful, so talk to your partner, friends, or a counsellor

Key takeaways

• See your GP after 12 months of trying if you are under 36, or after 6 months if you are 36 or older
• Go sooner if you have irregular periods, a known condition affecting fertility, or any specific concerns
• Initial investigations include a progesterone blood test, hormone profile, and semen analysis, all arranged by your GP
• Referral to a fertility clinic leads to further tests including tubal patency and AMH
• NHS referral timelines vary by area, so ask your GP about local pathways
• Continue healthy lifestyle habits and take supplements while waiting for appointments

Sources

• NHS. Infertility: diagnosis. nhs.uk
• NICE Clinical Guideline CG156. Fertility problems: assessment and treatment. 2013, updated 2017
• RCOG. Fertility: assessment and treatment. Patient information. 2023
• Fertility Network UK. Your fertility journey. fertilitynetworkuk.org
• HFEA. Getting help. hfea.gov.uk