Infertility referral checklist

Urgency tier

• Female age 40 or older or rapidly declining fertility history.
• Amenorrhea or oligomenorrhea with suspected endocrinopathy.
• History of PID, ectopic pregnancy, or pelvic surgery.
• Known uterine or tubal abnormalities.
• Severe male factor findings on semen analysis.

Minimum pre-referral workup

• Duration of trying to conceive and timing of intercourse.
• Semen analysis for partner.
• Ovulation assessment based on cycle history and/or progesterone.
• TSH and prolactin when indicated.
• Pelvic ultrasound and STI screening if risk factors.

Referral packet checklist

• Duration of infertility and prior pregnancies or losses.
• Menstrual regularity and ovulation assessment results.
• Semen analysis results and partner history.
• Relevant labs and imaging reports.
• Comorbidities, medications, and lifestyle factors.

Pre-referral optimization tasks

• Optimize preconception counseling, including folic acid and chronic disease control.
• Address modifiable factors such as smoking, alcohol, weight, and intercourse timing.
• Set follow-up to confirm all baseline tests are complete before specialist review.

References

• Canadian Fertility and Andrology Society Choosing Wisely (opens in a new tab)

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