This study aimed to observe diagnostic work-up and cost evaluation of infertile couples to identify opportunities for improvement. One hundred and seventy-four new referrals to the gynaecology clinic in a District General Hospital during 1996 and 1997 provided the cohort for analysis. Data from case notes were transferred on to data collection sheets. Data were inputted into SPSS for analysis. Primary @entity249 accounted for 62% of couples. One hundred and forty-two couples (81.6%) had a definitive diagnosis, and the analyses relate to these couples only. There was no single investigation performed on the whole cohort studied. Semen analysis was undertaken in 80.3% of the couples; couples with suspected @entity4810 were over four times more likely to have had more than two semen tests (P = 0.0005); 77.5% of couples had FSH and LH tests; and midluteal @entity1420 was tested in 76.1%. An increased intensity of FSH-LH hormone testing was associated with couples with @entity3206 (chi(2) = 6.79, P = 0.03). Serial repeat @entity1420 tended to be given to @entity1 with irregular or prolonged cycles (35 days or more), although this tendency was not statistically significant. The most common test for tubal patency was hysterosalpingography. Higher costs are generally associated with diagnosing @entity46 and tubal factor because of the relatively high cost of laparoscopy. The average cost of diagnosis for each @entity1 was pound 365 and ranged from pound 64 to pound 851. In conclusion, a standard protocol of basic investigative procedures should be offered in secondary centres to all couples. Avoiding duplication and unnecessary investigations (for example, serial @entity1420 ) may reduce costs, although offering all couples a standard protocol of tests would probably offset this observation.

Diagnosing XXXX in a district general hospital: a case-note and cost analysis.

@entity1 :: ('9606', 'Species') :: ['women', 'patient'] @entity249 :: ('MESH:D007246', 'Disease') :: ['infertility'] @entity4810 :: ('MESH:D007248', 'Disease') :: ['male infertility'] @entity1420 :: ('MESH:D011374', 'Chemical') :: ['progesterone'] @entity3206 :: ('MESH:D000858', 'Disease') :: ['anovulation'] @entity46 :: ('MESH:D004715', 'Disease') :: ['endometriosis']
@entity249 :: (MESH:D007246,Disease) :: ['infertility']
