Quality statement 2: Referral for specialist consultation
Quality statement
People are referred for specialist consultation if conception has not occurred after 1 year of intercourse or after 6 cycles of artificial insemination, or at presentation in certain circumstances. [2014, updated 2026]
Rationale
Over 80% of heterosexual couples where the woman is aged under 40 years will conceive within 1 year if they have regular unprotected vaginal intercourse at and around the time of ovulation. If they do not conceive after 1 year, or after 6 cycles of artificial insemination, they should be referred to specialist services to decide if more support is needed. Women, trans men and non-binary people with female reproductive organs aged 36 years or over and people with a suspected or known clinical cause of infertility or history of predisposing factors for infertility should be offered referral at presentation because of the impact of these factors on fertility. Delays in referral to specialist services can have a negative impact on patient care and treatment outcomes.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Process
a) Proportion of people (women, trans men and non-binary people with female reproductive organs aged 35 years or under and men, trans women and non-binary people with male reproductive organs) who are referred for specialist consultation if conception has not occurred after 1 year of intercourse or after 6 cycles of artificial insemination, where there is no suspected or known clinical cause of infertility or history of predisposing factors for infertility in either person.
Numerator – the number in the denominator who are referred for specialist consultation.
Denominator – the number of people (women, trans men and non-binary people with female reproductive organs aged 35 years or under and men, trans women and non-binary people with male reproductive organs) who have not conceived after 1 year of intercourse or after 6 cycles of artificial insemination, where there is no suspected or known clinical cause of infertility or history of predisposing factors for infertility in either person.
Data source: The Human Fertilisation and Embryology Authority (HFEA) national patient survey collects data on the timing of starting treatment following first contact with a GP, including reasons for delays in starting treatment such as waiting for referrals and appointments. Data can also be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
b) Proportion of people who are referred for specialist consultation at presentation when there is a suspected or known clinical cause of infertility or a history of predisposing factors for infertility, or the woman, trans man or non-binary person with female reproductive organs is aged 36 years or older.
Numerator – the number in the denominator who are referred for specialist consultation at presentation.
Denominator – the number of people who have not conceived and have a suspected or known clinical cause of infertility or a history of predisposing factors for infertility, or the woman, trans man or non-binary person with female reproductive organs is aged 36 years or older.
Data source: The HFEA national patient survey collects data on the timing of starting treatment following first contact with a GP, including reasons for delays in starting treatment such as waiting for referrals and appointments. Data can also be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
What the quality statement means for different audiences
Service providers (primary care, secondary care and specialist fertility services) ensure that referral pathways are in place so that people who have not conceived are referred for specialist consultation after 1 year of intercourse or 6 cycles of artificial insemination, or at presentation, depending on the presence of suspected or known infertility factors and the age of the woman, trans man or non-binary person with female reproductive organs.
Healthcare professionals refer people for specialist consultation if they have not conceived after 1 year of intercourse or 6 cycles of artificial insemination, or at presentation, if there are suspected or known infertility factors and based on the age of the woman, trans man or non-binary person with female reproductive organs.
Commissioners ensure that there is sufficient capacity within specialist services and that agreed pathways and referral criteria are in place for people who have not conceived to be referred for specialist consultation after 1 year of intercourse or 6 cycles of artificial insemination, or at presentation, if there are suspected or known infertility factors and based on the age of the woman, trans man or non-binary person with female reproductive organs.
People finding it difficult to get pregnant are referred for specialist advice and tests if they have been trying for a year or longer or have had 6 cycles of artificial insemination (which is the direct insertion of sperm into the womb or the neck of the womb). If they have a suspected or known problem that might affect their fertility, or are aged 36 years or older, they should be referred at presentation.
Source guidance
Fertility problems: assessment and treatment. NICE guideline NG257 (2026), recommendations 1.16.5, 1.16.6 and 1.16.8
Definitions of terms used in this quality statement
Circumstances for referral for a specialist consultation at presentation
A referral for a specialist consultation should be made at presentation if:
-
the woman, trans man or non-binary person with female reproductive organs trying to become pregnant is aged 36 years or over, or
-
either partner has a suspected or known clinical cause of infertility or a history of predisposing factors for infertility.
[NICE's guideline on fertility problems, recommendation 1.16.8. See NICE's guideline on fertility problems, terms used in this guideline, for a definition of suspected or known clinical cause of infertility.]
Specialist consultation
Assessment, investigation or treatment in secondary or tertiary care services (for example, urology departments, gynaecology departments or fertility clinics). [Expert opinion]