Trying for a baby can be an exciting time, but when things don’t go to plan as quickly as hoped, it’s completely normal to feel worried or unsure about what to do next. A great next step is to book an appointment with a Women’s Health GP (WHGP).

Many people are surprised to learn that a GP can complete most of the initial fertility work-up for both partners. In fact, this is often the most efficient and cost-effective way to begin investigating suspected subfertility, ensuring that by the time you see a fertility specialist, the right information is already available, and precious time isn’t lost.

In this blog, I’ll walk you through: why a WHGP is such an important part of early fertility care; what assessments they may do; and when referral to a fertility specialist is recommended.

Why See a Women’s Health GP (WHGP) First?

• Organisation of initial investigations, such as: initial blood tests; semen analysis; ultrasound scans; and any relevant screening tests for both partners
• Reviewing your medical history: a WHGP can review your background health, medications, menstrual cycle history, mental health, and lifestyle factors — all of which can influence fertility
• Lifestyle advice and timing optimisation: many couples conceive with simple advice around cycle tracking, timing of intercourse, weight management, and / or optimising medical conditions (such as diabetes)
• Identification of issues that need urgent referral: some conditions require faster specialist review — for example, severe endometriosis, very irregular cycles, suspected tubal blockage, or significantly abnormal semen parameters
• It’s more cost-effective: WHGP consultations and tests can be Medicare-rebated. Starting investigations in general practice ensures you don’t pay higher specialist fees before you need to

Common Causes of Sub-fertility

Sub-fertility is defined as not conceiving after 12 months of regular, unprotected, penis-in-vagina intercourse (or 6 months if the woman is over 35). But many couples seek help sooner — and that’s entirely appropriate. The most common causes of subfertility are outlined  below.

Ovulation problems

Ovulation is when the ovary produces and releases an egg (or ‘ovum’). Issues with ovulation account for approximately 25% of cases of subfertility. Irregular or absent ovulation can be due to:

• Polycystic ovarian syndrome (PCOS)
• Thyroid disorders
• Elevated prolactin
• Low body weight
• High physical stress
• Perimenopause
• Diminished ovarian reserve

Sperm factors

Approximately 30 – 40% of sub-fertility is due to some combination of: low sperm count; poor  sperm motility (or movement); abnormal sperm shape; and / or sperm DNA damage.

Fallopian tube or pelvic factors

For spontaneous conception to occur, a woman’s egg and a man’s sperm need to meet, then join, in one of the women’s Fallopian tubes (in a process called ‘fertilisation’). Abnormalities of one / both Fallopian tubes are thought to account for 20 – 25% of sub-fertility, and may be due to:

• Past pelvic infections (such as chlamydia)
• Endometriosis
• Previous pelvic surgery
• Blocked or damaged tubes

Unexplained sub-fertility

Up to 20% of couples will have no clear cause even after full investigation — but treatment options still exist, and are often successful.

What to Expect at a WHGP Fertility Consultation

Your WHGP will begin by taking a detailed history from both you and your partner. This is a crucial step, and it’s completely normal for the consultation to feel thorough.

Your WHGP will then arrange several investigations, for both you and your partner. While there is a standard list of routine investigations in this context, emphasis will be placed on the suspected underlying cause of your sub-fertility, if one has become clear while taking your history.

Initial Investigations a GP Can Arrange

A comprehensive first-line work-up often includes investigations for both partners, as fertility is truly a shared issue.

For the female partner

• Ovulation assessment: progesterone blood test (ideally taken on day 21 of your cycle, or 7 days before your next expected period); and / or cycle tracking (if your periods are irregular)
• Hormonal blood tests: AMH (anti-Müllerian hormone) for ovarian reserve; TSH and thyroid antibodies; prolactin; testosterone / androgens if PCOS is suspected
• General health tests, including: full blood count (for anaemia); vitamin D; iron studies; screening for rubella and varicella immunity; and infectious disease screening (HIV, hepatitis B and C, and syphilis)
• A transvaginal pelvic ultrasound, to assess: ovarian structure and follicle count; uterine anatomy; presence of fibroids, polyps, ovarian cysts, adenomyosis and / or PCOS

For the male partner

• Semen analysis: this is one of the most important tests and should be done early in your work-up. It assesses sperm: volume; concentration (or ‘sperm count’); motility (movement); morphology (shape); and other parameters (such as DNA fragmentation). If the initial semen analysis shows any abnormalities, a second test should be performed
• Blood tests (if needed) are likely to include: FSH, LH and testosterone hormone blood tests; infectious disease screening; and sometimes genetic testing (if semen analysis results are very abnormal)

When Will a GP Refer to a Fertility Specialist?

Referral is recommended when:

• You’ve been trying for at least 12 months (if you’re < 35 years old)
• You’ve been trying for at least 6 months (if you’re > 35 years old)
• Semen analysis is abnormal
• Ultrasound shows concerning findings (e.g. large fibroids, possible blocked tubes, severe endometriosis)
• Menstrual cycles are very irregular or absent
• Endometriosis is suspected
• There is a known medical condition affecting fertility (such as cystic fibrosis in the male partner)
• Same-sex couples or single women seeking pregnancy using donor sperm

Our in-house fertility expert (Dr Melissa Cameron) consults with patients at Maven Centre, then can continue your specialist fertility care through the Melbourne IVF laboratories and centres elsewhere in Melbourne if needed.

Final Word

Your journey toward pregnancy should feel supported, informed, and collaborative. Starting by seeing a women’s health GP is one of the most effective ways to begin investigating fertility concerns: this ensures that the right tests are done early, potential issues are identified, and you’re connected quickly to specialist care if needed.

If you and your partner are struggling to conceive or are simply unsure where to begin, consider booking in with one of our women’s health GPs at Maven Centre, such as Dr Phillippa Wootton or Dr Amy Sinclair-Thomson. We’re here to help guide the process gently, efficiently, and with your goals at the centre of care.