As a fertility specialist, advanced laparoscopic surgeon and obstetrician, I get to support patients from their first steps in fertility right through to pregnancy and birth.
In my experience, many people arrive thinking IVF is their only option. But often, it’s not the first step, it’s the last. Early guidance from a GP can make a huge difference. It can ease anxiety, open up less invasive options, and help people access the right care sooner.
Starting with the Basics: Initial Workup and Lifestyle Factors
Most patients benefit from a structured initial workup: hormonal assessments, ovulation tracking and a basic semen analysis. These tests can identify or rule out common causes of infertility and help guide early management.
Lifestyle optimisation often plays a powerful, underestimated role. Weight, diet, smoking, alcohol use and stress levels can all impact reproductive function. Even small, sustainable changes can improve natural conception rates or enhance the success of low-intervention treatments.
First-Line Treatment Options
For patients with anovulatory cycles or hormonal irregularities, ovulation induction (OI) with letrozole or clomiphene can be highly effective. In appropriately selected patients, intrauterine insemination (IUI) may also be considered, particularly in cases of mild male factor infertility, cervical mucus issues or unexplained infertility with a shorter duration.
These approaches are often more cost-effective, less invasive and less emotionally taxing than IVF. For many, they represent the right balance of intervention and natural conception support.
The Role of Fertility Surgery
Some patients may have underlying structural issues that reduce the chance of natural conception, such as endometriosis, fibroids, polyps, adhesions or tubal blockage. Surgical management, such as laparoscopy or hysteroscopy, can be both diagnostic and therapeutic, and in some cases, may restore natural fertility entirely.
These procedures are often underutilised or delayed, especially when patients aren’t aware they’re an option. Early referral to a specialist with surgical expertise, such as myself or a Create Fertility colleague, allows us to assess whether a targeted surgical approach could help avoid the need for IVF.
IVF as Part of a Broader Continuum
There are, of course, cases where IVF is the most appropriate or only viable option, such as severe male factor infertility, bilateral tubal blockage or unexplained infertility that hasn’t responded to other approaches. But even then, it should be presented as part of a continuum, not a one-size-fits-all solution.
In my practice, I take a personalised approach to care, offering everything from lifestyle and cycle support to advanced surgical and fertility treatments when appropriate. It’s about finding the right next step for each person, not jumping straight to IVF unless it’s truly needed.
Case Study 1: Surgical Pathway Avoids IVF
A patient was 35 and had been trying for a year. Her GP sent her my way early because her periods were quite painful, something that often points to endometriosis.
We organised a laparoscopy, found moderate endometriosis, and treated it during the procedure. After a few months, her pain had eased and her cycles were more predictable.
Six months later, I got the good news, she’d fallen pregnant naturally. No IVF, just the right diagnosis and treatment at the right time.
Case Study 2: Unexplained Infertility and a Stepwise Approach
This couple was 37, healthy, and all their tests came back normal. That’s what we call unexplained infertility, frustrating, but common.
We started with timed intercourse, then moved to three rounds of IUI. When that didn’t work, we moved on to IVF, and the second cycle brought success.
By taking it step-by-step, they avoided jumping into IVF straight away, but still got to the treatment that worked for them when they needed it.
How GPs Can Help
GPs remain the first point of contact for most patients navigating fertility concerns. Your early input shapes their understanding of what comes next. By discussing the full range of options, and referring early when indicated, you can help patients feel empowered and informed, whether they need a few lifestyle changes, medication, surgery or eventually IVF.
If you’re ever uncertain about the next step for a patient, my colleagues and I are always happy to discuss complex cases or support you in deciding when referral might be appropriate.
