Retrospective review of the prevalence and management of infertility in women in one practice over a five year period

BACKGROUND: Subfertility in general practice is a common problem. However, most treatment is initiated in hospital. There may be a role for general practitioners in the treatment of some infertile patients. AIM: The aim of this study was to investigate the prevalence and management of infertility in women in general practice and to identify a specific cohort of patients potentially suitable for management in primary care. METHOD: The general practice notes of all women patients between the ages of 16 and 42 years who presented to their general practitioner with an infertility problem in the five years preceding July 1993 were analysed retrospectively. The patients were identified from the computer database of one Durham general practice. RESULTS: Fifty four cases were identified over the five year period, giving a prevalence of infertility in women in the practice of 15 per 1000 women. Of those who had a definite diagnosis made, 27% had an ovulatory disorder. Women with an ovulatory disorder tended to have a low serum day 21 progesterone level (90%); to present with primary infertility (80%); and to receive clomiphene as first line therapy (80%). The majority of ovulation induction therapy (95%) was initiated in secondary care. CONCLUSION: Ovulation induction therapy with clomiphene appears to be uncommon in general practice at present. Women requiring ovulation induction therapy may be a cohort of patients suitable for such management in general practice. These patients tend to present with primary infertility and to have a low mid-luteal progesterone level.