Gynecology World Conference 2026

Abstract

The clinical referral pathway was established by the Fertility Scotland Network for managing couples experiencing subfertility, from primary to secondary or tertiary care, as Once for Scotland' approach. Standard referral is indicated after one year of regular unprotected intercourse, or accelerated to six months for women aged over 35 or those with significant reproductive risk factors. Early referral is specified for complex conditions, including severe endometriosis, blocked tubes, and male infertility. 

Primary care clinicians must complete prerequisite investigations for both partners. For female partners, screening involves checking rubella immunity, a chlamydia swab, and a recent thyroid function test. Hormonal evaluations vary based on cycle regularity. For women with regular cycles, mid-luteal progesterone and if cycles are irregular, Day 1-5 FSH, LH, E2, PRL, Androgen profile are advised. Male partners require a semen analysis; cases presenting with severe oligozoospermia or azoospermia necessitate repeated sampling and secondary endocrine or genetic testing. Crucially, strict NHS eligibility criteria govern onward referral. Patients are excluded if aged over 45, if the female partner’s Body Mass Index (BMI) exceeds 35, or if either individual has undergone sterilization. Initial management requires prescribing folic acid and vitamin D, and mandates comprehensive lifestyle modifications, including total cessation of smoking and vaping.