Audit of primary care and initial secondary care investigations set against RCOG guidelines as standard in cases of subfertility.

Subfertility affects one in seven couples in the United Kingdom and is associated with considerable patient stress and anxiety. The RCOG, with the publication of the evidence-based guidelines, gives us clear recommendations on the initial investigation of the infertile couple. Against these guidelines we audited patient care over a period of 5 months in a dedicated consultant-led infertility clinic. Our results show that a considerable number of patients failed to have the correct advice clearly documented, and the initial primary care investigations of mid-luteal progesterone and semen analysis were performed correctly with results available in only 33% and 2% of occasions, respectively. There were, however, areas where the guidelines were adhered to very efficiently. To improve care we recommend the use of an infertility referral form for use in primary care upon which the practitioners can fill in the appropriate details and be guided on the necessary investigations.