Talking to Your GP About Fertility: What to Ask First

You have decided to ask for help, or you suspect you will need to soon, and you know a GP appointment is short. This post is the script I want you to walk in with. Four phrases that move the conversation, the seven baseline tests a GP can order before any specialist referral, and what to do if the response is "just keep trying for a year." (US readers: the equivalent first stop is usually a primary care physician or OB-GYN; the structure of the conversation is the same.)

A ten-minute GP slot is not the enemy. Going in vague is. I tell patients: name the override in the first sentence, then name the test list, then name the threshold for referral. Three specific sentences cover most of what the appointment needs to do.

What a GP can actually do for you on fertility

Most baseline fertility workup is GP-orderable in the UK under NICE Clinical Guideline 156.¹ The same is true for most primary care physicians and OB-GYNs in the US. Specifically, your GP can:

• Take a focused history covering cycle pattern, previous pregnancies, surgeries, conditions, and partner history.
• Examine you and arrange initial blood tests.
• Order a semen analysis for your partner.
• Refer to a fertility or gynaecology clinic when criteria are met.

The baseline workup the GP can order without a referral typically includes day 2 to 5 FSH, LH, and oestradiol; mid-luteal progesterone; TSH; prolactin; AMH where locally funded; rubella immunity; chlamydia screen; and a semen analysis for the partner.^{1 3 4}

What GPs typically cannot do directly is a fertility-clinic pelvic ultrasound, a hysterosalpingogram or hysterosalpingo-contrast sonography (HSG/HyCoSy), or prescribe ovulation induction medication. Those sit with the fertility service. Knowing that boundary lets you save the GP slot for what the GP can actually do.

The four phrases that move the conversation

A ten-minute appointment is enough time if you bring specific sentences. These four phrases, in roughly this order, cover what I would want a patient to say in their first fertility-focused GP visit.

1. "I want to be evaluated for fertility, not reassured." This sets the visit as a workup, not a check-in. It moves the GP from the "talk through your worries" script to the "order baseline investigations" script.
2. "Here is my situation specifically." Then name the override: your age, your cycle pattern, the known condition (PCOS, endometriosis, thyroid disease), or the partner history (testicular surgery, mumps after puberty, chemotherapy). Specific overrides override the default "try for a year" script.
3. "I would like baseline bloods today, including FSH, LH, oestradiol, progesterone, TSH, prolactin, AMH if available, and a semen analysis for my partner." Naming the tests prevents the appointment ending with a vague "we will see how things go."
4. "What is the threshold for a fertility referral here, and how long is the wait?" This surfaces the local pathway. In the UK the referral criteria and waiting times vary by Integrated Care Board (ICB). Knowing the timeline now lets you plan around it.

These are not aggressive phrases. They are specific. Specific is what ten-minute appointments are built for.

What to bring (and what to write down before you walk in)

Prepare these ahead of the appointment so the slot is not lost to history-taking.

• A three- to six-month cycle log: day 1 of each period, cycle length, flow, any spotting, any pain. If you have not been tracking, estimate.
• The date you started trying, or planning to.
• Past obstetric history: previous pregnancies, miscarriages, terminations, ectopic pregnancies.
• Past gynaecology history: surgeries, ovarian cysts, fibroids, STI history (chlamydia in particular).
• Current medications and supplements for both partners.
• Partner's relevant medical history, especially childhood testicular surgery, mumps after puberty, varicocele, cancer treatment, or anabolic steroid use.
• Any tests already done privately, with the lab reports if possible.

Written prompts make ten minutes work. I have never seen a GP frustrated by a patient who arrived with a one-page summary; I have seen many appointments wasted reconstructing dates from memory.

The baseline workup to ask for

This is the request list. Not every test will be available at every practice or in every ICB, but knowing the names lets you ask by name and accept substitutions intelligently.

• Day 2 to 5 of cycle: FSH, LH, oestradiol. Early-follicular signal about ovarian reserve and pituitary signalling. Timed only.
• Mid-luteal progesterone: day 21 of a 28-day cycle, or seven days after suspected ovulation. Confirms whether ovulation actually occurred in that cycle.
• TSH and free T4: thyroid function.
• Prolactin: rules out hyperprolactinaemia, which suppresses ovulation.
• AMH where available: ovarian reserve marker. Some NHS regions fund this, others do not, and many treat it as specialist-only. If the local pathway does not include AMH, accept that and request the other bloods.
• Rubella immunity status.
• STI screen, chlamydia in particular. Chlamydia is often asymptomatic and a known cause of tubal damage.
• Semen analysis for the partner, at a recognised lab, two to seven days of abstinence before sample, with reference values per WHO 6th edition criteria.^{1 2}

If your cycles are irregular and you suspect PCOS, also ask for testosterone, sex hormone binding globulin (SHBG), free androgen index, fasting glucose, and HbA1c. These move the conversation toward a PCOS workup rather than generic fertility tests.⁵

When the GP can refer to a fertility clinic

The thresholds for referral broadly track the age-based timelines covered in our pillar on when to see a fertility doctor:

• Under 35: after twelve months of trying without conception.
• 35 to 39: after six months.
• 40 and over: typically immediate referral.

Immediate referral regardless of trying duration is appropriate if there is a known cause of infertility, prior abdominal or pelvic surgery, a history of pelvic inflammatory disease, partner history of undescended testes or testicular surgery, prior chemotherapy on either side, or planned cancer treatment.¹

A note on NHS-funded IVF eligibility in the UK. Eligibility is set by each ICB and is genuinely a postcode lottery. Criteria can include BMI cut-offs, age limits, prior children in the relationship, relationship duration, and smoking status. Ask the GP for the local ICB criteria at the first appointment, before any treatment decisions. It is not a question they will be offended by.

If the GP pushes back

Not every GP appointment goes smoothly. Three responses come up often, and each has a polite but firm reply.

• "Just keep trying" without acknowledging your specific situation is not a complete answer. Restate the override: "I understand the general rule, but I am [age / cycle pattern / known condition / partner history], and I would like baseline tests now rather than waiting."
• "We have to wait a year" when you have an override: NICE CG156 explicitly allows earlier investigation in the specific situations listed in the post on signs you might need fertility help sooner.¹ You can quote the guideline politely without being adversarial.
• "AMH is not on our local pathway": accept that, but ask for the bloods that are. FSH, LH, oestradiol, progesterone, TSH, prolactin, and semen analysis are almost always available.

If you genuinely cannot get the workup you need, the options are to ask for a different GP at the practice, to speak to the practice manager about the fertility pathway, or to pay privately for an initial fertility consultation and bring the report back to your GP for onward NHS care. None of these is failure. They are how the system actually works when a single GP slot is not enough.

Specific scripts for hard situations

If your situation falls into one of these specific patterns, a sentence-level script helps the appointment move faster.

• Long cycles with possible PCOS: "My cycles are [X] days, and I have [acne / hirsutism / hair thinning]. I would like to be investigated for PCOS, including testosterone, SHBG, fasting glucose, HbA1c, and a pelvic ultrasound referral."
• Severe period pain with TTC plans: "I have had cyclical pain that affects my daily life and I would like to be assessed for endometriosis before TTC, not after a year of failed cycles."
• Partner with relevant history: "My partner had [testicular surgery / mumps after puberty / varicocele / chemotherapy], and we would like a semen analysis as part of our initial workup, not in twelve months."
• Age 35 or over: "I am [X] years old, and I would like to begin investigation now rather than wait the standard twelve months, in line with NICE guidance."

Scripts feel awkward to use the first time. They are not meant to be recited word for word. They are meant to be a starting line you can adapt in your own voice.

What happens after the appointment

A few practical notes on what to expect once the bloods are ordered.

Routine bloods typically take one to four weeks for results, depending on labs and cycle timing. Some tests are timed: day 2 to 5 FSH must be drawn in the early follicular phase, and mid-luteal progesterone needs roughly seven days after ovulation. Book the blood draw for the right cycle day, not on the day that is most convenient.

Results come back via phone, an online portal, or a follow-up appointment depending on the practice. Read them as a set, not one at a time. A single AMH number or a single FSH number means little outside its context.

Semen analysis usually takes two to four weeks for results. A single abnormal result should be repeated six to twelve weeks later before any conclusion is drawn, per WHO guidance.² One bad sample is not a diagnosis. Spermatogenesis is a roughly seventy-four-day process and a fever, an illness, or a stressful week can throw a single result. The post on how to read a semen analysis covers what each parameter means.

If a referral letter is generated, expect four to twelve weeks to a first specialist appointment in the UK, longer in some ICBs. If you are private or paying out of pocket, often within two to four weeks.

What to do this week

• Book the GP appointment now. Do not wait for a "good" cycle day; the GP can plan timed bloods around your next cycle.
• Start a cycle log: day 1, length, flow, pain, spotting. Even three cycles of data are enough to make a conversation specific.
• Bring written notes. Print this post or write your own summary. Ten minutes works when the inputs are organised.
• Ask your partner to come, or to send their medical history in writing if they cannot attend. Partner history changes the workup.

What's next

• For the age and timing context: When to See a Fertility Doctor
• For the specific overrides that mean you should not wait the year: Signs You Might Need Fertility Help Sooner
• If you are still in the preparation phase: Preconception Checklist
• For couple-alignment before the appointment itself: Should We Start Trying: The Conversation

Sources

1. National Institute for Health and Care Excellence. Fertility problems: assessment and treatment. NICE Clinical Guideline CG156. 2013, updated 2017. https://www.nice.org.uk/guidance/cg156
2. World Health Organization. WHO Laboratory Manual for the Examination and Processing of Human Semen, 6th edition. Geneva: WHO; 2021. https://www.who.int/publications/i/item/9789240030787
3. Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile female: a committee opinion. Fertility and Sterility 2015;103(6):e44-e50. https://www.asrm.org/practice-guidance/practice-committee-documents/diagnostic-evaluation-of-the-infertile-female-a-committee-opinion-2015/
4. Practice Committee of the American Society for Reproductive Medicine. Diagnostic evaluation of the infertile male: a committee opinion. Fertility and Sterility 2015;103(3):e18-e25. https://www.asrm.org/practice-guidance/practice-committee-documents/diagnostic-evaluation-of-the-infertile-male-a-committee-opinion-2015/
5. Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Fertility and Sterility 2023;120(4):767-793. https://www.fertstert.org/article/S0015-0282(23)00733-3/fulltext
6. Royal College of Obstetricians and Gynaecologists. The Investigation and Treatment of Couples with Recurrent First-trimester and Second-trimester Miscarriage. Green-top Guideline No. 17. London: RCOG; 2011 (updated 2023). https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/
7. ESHRE Guideline Group on Female Fertility Assessment. ESHRE guideline: female fertility assessment. Human Reproduction Open 2024. https://www.eshre.eu/Guidelines-and-Legal/Guidelines