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Investigating infertility and understanding fertility

How is infertility diagnosed?

If you have been having regular, unprotected sex for one year and have not become pregnant, your doctor should initiate investigations or refer you to a fertility clinic. If you are aged 35 or over, you may be referred for investigations after six months, as the chances of becoming pregnant declines with age and you may need prompt intervention to improve your chances of conceiving.

Many different health conditions and lifestyle factors can affect fertility, so you might need to undergo several types of tests and investigations as your doctors try to find out why you are not becoming pregnant. You and your partner will both need to undergo tests.

Read more about the causes of infertility

Fertility Tests for Women

When you first see your doctor, they will examine you for any signs of infection or gynaecological issues.

Your doctor will ask you about your periods, and you will have a blood test to check your progesterone levels to confirm that you are ovulating. If your periods are irregular, you may also have a blood test to check your follicle-stimulating hormone (FSH), luteinising hormone (LH) and other hormone levels.

Fertility issues are often caused by blocked fallopian tubes or the ovaries not working as they should. Therefore, your doctor or fertility clinic will arrange tests to check both these functions. An internal scan, called a transvaginal scan, is used to visualise the ovaries, fallopian tubes, and uterus to check for abnormalities

In some particular types of scan, a dye can be injected into the uterus so that your sonographer can see whether it passes through both fallopian tubes freely.

Your doctor or fertility clinic may also refer you for a laparoscopy (keyhole surgery) for further investigations.During a laparoscopy, your doctor looks inside the pelvis with a camera to check the health of your tubes, uterus, ovaries, and surrounding tissues.

Fertility Tests for Men

Your partner will have an initial examination from their doctor that includes checking the penis and testicles to check for any signs of medical issues that could be impacting fertility.

The next step of testing is to perform a semen analysis. Semen is the fluid released during ejaculation that carries the sperm.

Your partner will need to abstain from sex for 2-5 days before producing a semen sample. The laboratory will check the sperm count, how healthy it is, and how well it can propel itself forward (called sperm motility).

Your partner might be asked to repeat the test after some time as having two or more tests produces a more accurate result.

Treatments to improve fertility

The most suitable fertility improvement treatment for you will depend on the findings of your investigations. There are three main areas of fertility treatment.

  • Medication that stimulates the ovaries to encourage egg production and release.
  • Assisted reproduction technologies (ART) including:
    • In vitro fertilisation (IVF) where eggs are collected from the woman then mixed with sperm in a laboratory. One or two of the healthiest fertilised embryos are then put back into the uterus to implant.
    • Intrauterine Insemination (IUI) where sperm is injected through the cervix and into the uterus at around the time of ovulation. If your ovaries are not ovulating reliably, you may need medication to help them.
    • Intracytoplasmic sperm injection (ICSI) where a sperm is placed directly into the egg under a microscope. ICSI is a suitable option when sperm quality or motility is an issue.
  • Surgery to correct any abnormalities, such as removing scar tissue that may restrict the fallopian tubes or remove fibroids.