Infertility/RPL
Emergency department referrals
All urgent cases must be discussed with the on call Registrar to obtain appropriate prioritisation and treatment. Contact through:
- Royal Brisbane and Women's Hospital (07) 3646 8111
- The Prince Charles Hospital (07) 3139 4000
- Redcliffe Hospital (07) 3883 7777
- Caboolture Hospital (07) 5433 8888
Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.
Does your patient wish to be referred?
Minimum referral criteria
Does your patient meet the minimum referral criteria?
Category 1
Appointment within 30 days is desirable
- 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 days is desirable
- Category 2 referral for infertility are not accepted, refer to private specialist to avoid delay
Category 3
Appointment within 365 days is desirable
- All referrals for infertility for example but not limited to:
- Surgical management of hydrosalpinx
- Anovulation for ovulation induction (selected case)
- Unexplained infertility (selected cases)
- Recurrent pregnancy loss
(Definition – Infertility is the failure to achieve pregnancy after 12 months or more of unprotected intercourse)
If your patient does not meet the minimum referral criteria
Consider other treatment pathways or an alternative diagnosis.
If you still need to refer your patient:
- 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
Other important information for referring practitioners
Not an exhaustive list
- Refer to HealthPathways for assessment and management information if available
- Mature age referrals (38yo) direct referral to private so as not to waste productive time
- 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
- 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
Referral requirements
A referral may be rejected without the following 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 +/- 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
- Pelvic USS (TVS preferable)
- If PCOS is suspected include the following:
- Free androgen index (FAI) or Free Testosterone
- Fasting blood glucose results
- 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)
- Autoimmune 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
Additional referral information (useful for processing the referral)
- Body mass index (BMI)
- 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 infusine uss (sonohysterography)
Out of catchment
Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.
- 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
- 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
- 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
- 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
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
- 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.)
Send referral
Hotline: 1300 364 938
Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs
Mail:
Metro North Central Patient Intake
Aspley Community Centre
776 Zillmere Road
ASPLEY QLD 4034
Health pathways
Access to Health Pathways is free for clinicians in Metro North Brisbane.
For login details email:
healthpathways@brisbanenorthphn.org.au
Login to Brisbane North Health Pathways:
brisbanenorth.healthpathwayscommunity.org