Most people who eventually receive NHS-funded IVF started the process with a GP appointment that felt inconclusive, were told to keep trying, or waited longer than they should have before getting the right tests. The NHS fertility pathway is not always clearly signposted — and the earlier you understand how it works, the better positioned you are to navigate it efficiently.

When Should You See a GP About Fertility?

NICE guidelines recommend seeking help if:

  • A woman under 35 has not conceived after 12 months of regular unprotected sex
  • A woman aged 35 or over has not conceived after 6 months
  • There is a known fertility factor — irregular periods, previous pelvic inflammatory disease, a male partner with a prior semen analysis concern, endometriosis diagnosis — in which case earlier referral is appropriate regardless of how long you have been trying

If you fall into any of these categories, you are not going too early. A GP appointment to initiate investigations is appropriate now.

Step 1: The GP Appointment

At the initial GP appointment, ask explicitly for a fertility investigation referral. The GP should:

  • Take a history from both partners (if applicable)
  • Arrange blood tests for the woman: day 2–5 FSH and LH, day 21 progesterone (to confirm ovulation), AMH (in some areas), thyroid function, rubella immunity
  • Arrange a semen analysis for the male partner
  • Ask about cycle regularity, previous pregnancies, sexual history, and relevant medical history

What to say if your GP is hesitant: "I have been trying to conceive for [X months/years] and I would like to start fertility investigations as recommended by NICE guidelines. Can you arrange the initial blood tests and a semen analysis?"

Do not leave without a clear next step — either a test request or a follow-up date.

Step 2: Initial Investigations

The standard first-line investigations are:

For the woman:

  • Day 2–5 FSH and LH: Assesses ovarian reserve and the balance of pituitary hormones. Elevated FSH suggests reduced reserve.
  • Day 21 progesterone: Confirms whether ovulation occurred in that cycle. A level above 30 nmol/L indicates ovulation.
  • AMH (anti-Müllerian hormone): Measures ovarian reserve. Not universally available on NHS at GP level — some ICBs require specialist referral first.
  • Thyroid function (TSH): Thyroid disorders affect fertility and are easily treated.
  • Prolactin: Elevated prolactin can suppress ovulation.
  • Rubella immunity: Required before treatment.
  • Pelvic ultrasound: May be arranged to assess the uterus and ovaries. Antral follicle count (AFC) may be noted.

For the male partner:

  • Semen analysis: Volume, concentration, motility, and morphology. If the first result is abnormal, a repeat is usually done 6–8 weeks later. See male factor infertility and IVF.

Step 3: Onward Referral

Once initial investigations are complete, your GP refers you to a specialist fertility unit. This is typically:

  • A NHS fertility clinic attached to a hospital — usually the first stop for further investigation and potential treatment
  • A gynaecology department in areas without a dedicated fertility unit

The referral process varies by ICB. Some require the GP to have completed all initial investigations first; others accept referral before investigations are complete. Ask your GP which applies in your area.

Waiting times for the first fertility clinic appointment vary considerably by ICB — from weeks to over a year in some areas. Check NHS IVF waiting times for more on managing this period.

Step 4: The Fertility Clinic Appointment

At the specialist clinic, you will typically see a consultant or specialist nurse who will:

  • Review your investigation results
  • Arrange any further tests not yet done (hysteroscopy, laparoscopy for suspected endometriosis, more detailed semen analysis)
  • Assess whether you meet the ICB's eligibility criteria for NHS-funded treatment
  • Explain your treatment options and likely pathway

This appointment is the point at which NHS IVF eligibility is formally assessed. To check your ICB's current criteria before this appointment, use Nestie's NHS eligibility checker.

Common Reasons for Delays — and How to Address Them

GP unwilling to refer: Some GPs are reluctant to refer before 12 months of trying, even when NICE guidance supports earlier referral (e.g., if you are over 35 or have a known factor). If this happens, explicitly cite NICE guideline NG65 and ask for the referral in writing. You can also request a second GP opinion or self-refer to a private fertility clinic for initial investigations.

Long waiting list: Once referred, you are in the system, but waits for the first appointment can be lengthy. Use this time productively — ensure investigations are complete, review the ICB's eligibility criteria, and consider whether private treatment is an option while waiting. See how to reduce the cost of IVF.

Investigations lost or delayed: Blood test results sometimes do not reach the fertility clinic in time for the appointment. Follow up with your GP surgery a week before the clinic appointment to confirm results have been sent.

Age approaching eligibility limit: If you are approaching your ICB's upper age limit (commonly 39–42), tell your GP explicitly that referral is time-sensitive. Ask for an urgent or expedited referral, and document your request.

What If You Are Single or in a Same-Sex Relationship?

The NHS pathway applies equally to single women and same-sex couples, though some ICBs have additional criteria — such as a minimum number of donor insemination attempts before IVF funding is granted. Your GP should refer you for the same initial investigations. For more detail on how ICBs treat single women and same-sex couples, see single women and NHS IVF and LGBTQ+ couples and NHS IVF eligibility.

Frequently Asked Questions

Q: My GP told me to keep trying for another six months. I'm 37. What should I do?

A: NICE guidance recommends referral after six months of trying for women aged 35 and over — not twelve. If your GP is following the under-35 timeline for you, correct this politely and ask for an immediate referral. If they decline, request a written explanation or see a different GP.

Q: Can I be referred to a specific NHS fertility clinic?

A: You have the right under NHS choice to be referred to any NHS clinic in England, not just your local one. This is relevant if your local clinic has long waiting times or limited services. Ask your GP to refer you to your preferred clinic.

Q: Do both partners need to attend the GP appointment?

A: Not necessarily, but it is helpful for a semen analysis request. In some practices, the male partner will be asked to attend separately to have their information taken and a semen analysis arranged.

Q: I've already had private fertility investigations. Will the NHS accept these?

A: Sometimes. Some NHS clinics will accept recent private results (typically within 6–12 months) to avoid duplication. Others repeat all investigations as standard. Ask the fertility clinic when the referral is made.

Q: What happens after NHS-funded treatment ends?

A: If you have used your funded cycles without a live birth, the NHS pathway ends for that condition. You may still be able to access some NHS support (investigations, medication advice) but further treatment is typically private. See your NHS fertility rights for more on what you are entitled to.

This article is for information only and does not constitute medical advice. NHS policies vary by ICB — check your local eligibility criteria before making decisions.