Consulting the GP with worries about conceiving can be difficult. For many people who will be young healthy individuals, it is the first time they have had to consult the medical profession about anything more serious than a cold or vaccination. On the whole, people understand that the GP is the person who orders the initial investigations and tests and is the gatekeeper to the fertility specialists. Many were aware of the need to try to conceive for a year (or in some areas longer) before visiting their GP and had high expectations of what the first consultation would achieve.
Maggie said it was frightening when the GP told her she needed to be referred to a specialist.
Maggie said it was frightening when the GP told her she needed to be referred to a specialist.
Age at interview: 36
Sex: Female
Age at diagnosis: 30
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I just thought there would be something simple that we had overlooked. There wasn’t, and, and they said we needed to see a specialist. Which was very very scary. I remember at that point, I think this was the first of my bursting in to tears in doctors’ waiting rooms… " The first of many I have to say." I think the shock of it, and also it felt very serious all of a sudden. If we were seeing a specialist, a fertility specialist, then there was a problem with our fer tility.
Michelle found it embarrassing to see her GP with concerns about conceiving.
Michelle found it embarrassing to see her GP with concerns about conceiving.
Age at interview: 29
Sex: Female
Age at diagnosis: 28
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How did you feel about having to go and see the doctors to get pregnant in the first place? Did it bother you to have to go and have injections and investigations?
I think to start with you feel a bit embarrassed because you just take it for granted that you’re going to, it’s going to happen. And after a few months we bought books and they said that most couples it’s, you know, after twelve months. And as you, as soon as you hit thirteen months and you’re not pregnant you think well why not, have to go and tell the doctor because I think they. They’re so, what positions are we doing and how many times a week you’re having sex.
[laugh] Yeah they were, I think there’s a bit all the temperature taking was, well it’s not embarrassing obviously when you’re at home and you’re taking your temperature. When you go back and you’ve got all these graphs and charts and it was up and it was down and then nothing seemed to come of it. It made no difference. There wasn’t. It’s not as though you sat now with an Excel spreadsheet and analysed it all. No, it was like, thanks for doing that. So why bother. You know I’d even gone from the first month with all these charts from a normal thermometer I upgraded to a digital just so I was more accurate [laugh].
While people described examples of good and bad practice on the practical medical side of primary care – misinterpreting results, failing to do the referrals – it was the emotional and psychological support either offered or not offered by GPs that stands out.
Those who described a positive experience nearly always described feeling that their fertility concerns had been taken seriously. GPs may sometimes appear dismissive when they are trying to reassure couples that they will probably get pregnant without treatment (and of course many do). But the couples we talked to had very much appreciated GPs who committed time, organised referrals swiftly, seemed interested, were realistic and listened to their concerns. Lulu, for example said, “They listened, they were caring,” and “were very supportive”.
Catherine was worried after a few months of trying to get pregnant. Her GP was sympathetic, ran...
Catherine was worried after a few months of trying to get pregnant. Her GP was sympathetic, ran...
Age at interview: 45
Sex: Female
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I started having, trying to have a child when I was 30. And I knew, I’d always known that I wanted children, but until then I’d been kind of, you know, busy doing all those kind of career things and feeling settled. And I really felt when I was 30 that I was actually ready to have a family and that was what I wanted to do. And a lot of my friends had started having children. And when it didn’t happen within just a few months I actually started to get slightly worried. I think even then I was quite aware of my age. Although 30 is relatively young, I knew that, you know, my fertility would soon start diminishing. And also I knew that there were long waiting lists for treatment and for tests and for all those kind of things. So I actually went to see the GP probably after only about five months. And I was really lucky because my GP was actually incredibly sympathetic, and I know a lot of people get told to go away and keep trying. But he said, “Oh, no, I’ll do some tests straight away. We might as well rule out any problems immediately.” Which he did. And then he referred me to a clinic fairly quickly as well.
Anne's doctors was 'lovely' and arranged for blood tests straight away to check her hormone...
Anne's doctors was 'lovely' and arranged for blood tests straight away to check her hormone...
Age at interview: 41
Sex: Male
Age at diagnosis: 39
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Great and can you tell me about going to see the doctors when you started to find out, you know, suspect that there was a problem the second time round. Did you first go to a GP?
Yes. I went to my doctor at my old surgery where we used to live in [city] and he was lovely. And we said to him that we had been trying for over a year to have a baby and so he arranged for blood tests virtually straight away for me to check my hormone levels. And then as you probably can imagine said, “Well keep trying and come back in six months time if it has not worked again. And we will see if we can take it from there.”
But as I mentioned before I had had this really bad ovulation pain and so he wrote a letter to the hospital in [city] to ask for investigations and that is how I took the route of perhaps going to a fertility clinic but I never actually got the chance to go there.
In contrast some people felt that their GP didn’t take their worries very seriously and felt “fobbed off”. This was particularly disappointing for those who had waited over a year before going to see their GP. The short time available for GP consultations could be a problem.
Maggie and her husband had waited two years before going to see their GP. They had a lot of...
Maggie and her husband had waited two years before going to see their GP. They had a lot of...
Age at interview: 36
Sex: Female
Age at diagnosis: 30
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In the UK on the NHS, you have to have been trying for two years before you can consult your GP about infertility or the kind of potential prospect of infertility. So we made an appointment with our GP, who suggested some tests to make sure that I was ovulating correctly and that my husband’s sperm count was okay. She didn’t have a huge amount of time to talk to us about this. And I guess that was something that I did find hard. Because at, we’d been trying for two years at this stage, I’d got a lot of questions to ask, my doctor didn’t have the time to answer those questions. And that was quite hard, because I went away with a huge long list of questions that I didn’t know the answers to. We had this appointment with her that raised more questions than it answered. And also I think the GP had seen us as people who were educated, you know, degree level, and she talked about things, very complex medical things that were way over our heads. She talked about levels of hormones and this thing called FSH and all of these, lutenising hormone, and all of these things that we just didn’t know what it meant. But there wasn’t the time to ask or to, to get clarification for some of these terms. So I guess flattering though it was to receive the kind of consultation in that format, I didn’t understand a lot of what she was saying, was telling me.
So what would you, what would you have liked to have had from that consultation?
I think I would have liked my doctor to be able to, to maybe just give us some information to take home with us and to digest. Both of us were sitting in that meeting room with the doctor. My husband would have had his questions, I had my questions, she was trying to convey some information to us. There was words just flying about the place and I think, you know, very few of them actually went in for any of us. In a way I think it would have been good to have something, something that, written on paper that we could take away with us and digest, certainly about what our options were and the route that we would be taking. Because we didn’t have a huge amount of, well, fortunately neither of us have ever been particularly ill, so the whole process, the kind of, you know, GPs and nurses and consultants and hospital visits was alien to us. We didn’t understand how it worked. You know, it, that was quite confusing. It sounds silly but, you know, we’d, we’d been lucky up to that point of never having to re-, to use the NHS, and we didn’t understand how it worked.
Martha felt that her GP did not give them enough time when she went to see him with concerns...
Martha felt that her GP did not give them enough time when she went to see him with concerns...
Age at interview: 34
Sex: Female
Age at diagnosis: 30
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It was a him. And I have to say he is really great. He is one of our, you know, favourite doctors. But through that, I was kind of surprised actually that he was as offhanded as he was about it. Because he was another one, who just said, “Oh well. You have already got a child.” You know, “It is obviously just going to happen. It is just taking a bit more time. Ra ra ra.” And he also, you know, he did say, somewhat apologetically you know, “Oh well it is two years before we will do anything anyway.” And… I guess he probably, I can’t remember if it was that first visit as well or whether I went back again. That was when he said, “Well we can do some sort of ovulation tests to make sure, you know, but that is all…” You know, but it was very much like, oh kind of, “Why are you here?” You know, “You already have a child so obviously you can. You are taking up our time with this.” You know, kind of thing.
Which must have felt awful?
Yes, especially when you go in there thinking okay I have waited my year. Finally they are going to do something. And then you are told, no go back and do it and for another year.
I don’t know whether anybody, I don’t know whether it is because GP’s probably aren’t exposed to it very much or whatever, but having said that when we were sent to the OBGYN, what you call it, the gynaecologist who is connected with our practice for those tests. I mean he was exactly the same, and so I mean I would like to write it off and say the GP’s just don’t have the experience, but then he probably does and he said the same thing. The kind of why are you here, you have already got one, you know, there shouldn’t be a problem, kind of thing. And I think that I was just, you know, sort of shocked that they could overlook how completely destructive this was, you know, for all of us in the family and to an extent, you know, beyond it as well.
Occasionally people told us that their GP had been insensitive or did not seem to understand the impact of infertility. Joanna was appalled that her GP said “Well you’ve had most of your life without children, why did you suddenly decide you want children?” She said she would have appreciated a little more understanding.
Janine felt that her GP and practice nurse did not understand the psychological as well as...
Janine felt that her GP and practice nurse did not understand the psychological as well as...
Age at interview: 44
Sex: Female
Age at diagnosis: 32
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Well I suppose because it’s such an emotional thing and a psychological thing, you know, trying to have a child and worrying that you’re not going to be able to have a child, then I’m not sure that GP’s are very, well I’m [not] sure that they have the time really to deal with that. So whenever I went to the GP it was very much about this sort of consultation about, you know, hormones and periods and temperature, and so all these physiological things he was[n’t] interested in. But each time I went I was having to I suppose engage with all of the emotional side of it. So rather like if I was at work or something I could sort of push that to the back and forget about it a bit. So I think that was the frustrating thing about going to the GP.
Because I remember one, I went to see, it was the practice nurse and I had to, I think she gone to take, is it working, she’d gone to take some blood and it had to be at a certain point in my cycle and I think my period had started early so she couldn’t take the blood and so I went anyway, and said, “Can..” Because I wasn’t sure. “Can you still take the blood?” And she said, “No.” And just sort of sent me home. And I remember coming out crying thinking, if she, bless her actually appreciated at all that actually you know, I’d waited all month to go for that blood test and I was going to have to wait another month, which was putting off finding out what on earth is going on with me body for another month.
So, and then the GP was just not very good at recognising infertility as a psychological emotional thing as well as a physiological thing.
The fertility clinic usually became the main focus of care once treatment was underway but some GPs clearly maintained their interest and support for couples.
Steve and his wife went through treatment unsuccessfully before they adopted two boys. He described his GP as, “A lovely old fashioned Dr Finlay’s casebook kind of GP who was probably incredibly politically incorrect but he was actually also one of the most supportive medical staff that we came across. And he was genuine in his support and his irritation that there wasn’t more help available to us, in terms of funding, and you know why he couldn’t maybe give us drugs on prescription ….he was so lovely.”
Marine had several IVF cycles before successfully conceiving her daughter. She and her husband really appreciated the advice that their GP gave them as they embarked on treatment reminding them that there would be lots of choices ahead of them but they could stop at any time.
Marine thought her GP was really good because she warned her that there would be lots of choices...
Marine thought her GP was really good because she warned her that there would be lots of choices...
Age at interview: 37
Sex: Female
Age at diagnosis: 33
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She was really good, because we came after the year after the ectopic and said, “Okay we’ve tried ra ra ra.” And she said, “That’s fine. I’m going to refer you. This is what’s going to happen. You need a sperm test. You go to see the infertility nurses.” And then she said, “Remember this could be a long process and there’s a lot of choices coming up that you need to make and remember that at any point you can say no.” So she was really good actually, yes, she was brilliant. Hm. Hm.
So she kind of warned you about the sort of choices?
Yes, yes, she didn’t go through exactly what it was, but she just said, “Remember it’s easy to be just swiped into it. You don’t, you can stop at any point.” So yes, she’s great, yes, yes.
Marine's GP was very good at referring her after her ectopic pregnancy.
Marine's GP was very good at referring her after her ectopic pregnancy.
Age at interview: 37
Sex: Female
Age at diagnosis: 33
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And then a year afterwards, we went to a GP, she was great, she was like yes, okay no need to wait any longer now. She referred us and we went to the hospital for investigations. And that was, they were fantastic, the fertility nurses there were just great. So if anyone has a choice, definitely choose that. But it took so long to do that dye test on my tubes because the one person that could do it at the hospital was off sick. So that just, was dragged out.
Last reviewed July 2017.
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