If you and your partner have not become pregnant after a year of trying, you may have a fertility problem, and it is worth seeking medical help. If the woman is over 35, it may be a good idea to start checking things out even earlier, after to six to nine months. Infertility investigations can sometimes take a long time, even years. If you put off seeking help now, you could be leaving it too late.
How do we start?
Step 1: Make an appointment with your GP, who can refer you to a gynaecologist who specialises in infertility. Make sure that you see an infertility specialist with CREI qualifications – he or she will be more up-to-date with the latest investigations and treatments than other gynecologists. If you don’t want to see a private doctor, fertility clinics exist in a number of large hospitals, and you can call one of these to make an appointment directly.
Step 2: You will need to see the specialist together.
Both of you can expect to be asked a lot of personal questions: your general health and history of illnesses; frequency of intercourse, sexual history, type of work.
The woman may have an internal examination.
This session should take about an hour.
Step 3: The doctor may suggest that the woman does some temperature charts – these can help to determine time of ovulation. They may suggest, once you have determined
the time of ovulation, that you time intercourse to co-incide with it.
Your doctor will suggest a number of tests – the easiest ones first: blood tests to check the woman’s hormone levels, a semen analysis, and a post-coital test. In this, the woman’s cervical mucus is examined under a microscope several hours after intercourse, to see if the sperm are still surviving and healthy. The semen analysis is sometimes (incorrectly) called a sperm count. It looks at the number of sperm, their motility (ability to swim) and their morphology (shape). It is quite normal to have a proportion of sperm which are abnormal. However, if the test suggests a problem, then the man may
be referred to an andrologist (a doctor who specialises in men’s reproductive systems).
If all of these tests show no abnormalities, you may be advised to have some more involved investigations. These commonly include a hystersalpinogram (an x-ray of the
uterus and fallopian tubes) and a laparoscopy. Under a general anaesthetic, a small telescope-like instrument is inserted through a cut in the navel, to examine the areas around the woman’s uterus and fallopian tubes.
What should you do in a specialist’s appointment?
Take a list of questions in with you, and write down the answers (sometimes your anxiety can cause you to forget what you wanted to ask, or what the answers were).
Ask for copies of all your test results, and keep them in a folder at home, as there may come a time when you want
to change doctors, or seek a second opinion.
Ask whether your semen analysis is being done by a specialised infertility laboratory – they often have
different standards to the regular pathology laboratories.
Ask your doctor to explain what the tests and
the results mean.
Ask your specialist to keep your GP filled
in on what is happening.