Investigating infertility

This article on investigating infertility explains the most commonly used investigations to check for infertility in men and women.

Why am I not pregnant yet?

The majority of children play at being ‘mums and dads’ and many adults presume they will be parents some day. For many it is a great blow when they decide they would like to have a baby (often after many years of trying not to have one!) and it just doesn’t happen.

At what point does ‘not getting pregnant’ become infertility? There is no clear answer to this question.

If a couple are having regular sexual intercourse, without the use of any contraception, but do not conceive a baby within 1-2 years, they may be experiencing a fertility problem. The majority of couples will be pregnant within one year and a few more will be pregnant within two years – the amount of time that they try to conceive before seeking ‘professional advice’ will depend upon many factors, such as –

• the age of the couple
• any previous medical problems which could affect fertility
• their level of anxiety or embarrassment around their fertility
• previous pregnancies together, or with previous partners.

The right time to seek advice is when you suspect that you have a fertility problem and wish to speak to someone about it.

Initial investigations for infertility

The majority of people approach their family doctor, or GP, in the first instance. They will ask about previous medical history, particularly related to your reproductive and sexual health (for example, any previous pregnancies or sexually transmitted infections) and will ask about how long you have been trying to conceive a baby.

Much of their advice will depend upon your own personal circumstances. For example –

• If you are both in your late 20s, healthy, and have been trying for under one year, the doctor may suggest that you continue to try to get pregnant, then return for investigations if you are not pregnant in another 6-12 months.
• However, if you are both in your late 30s, or there is a possible problem caused by a previous infection or surgery, then the doctor may suggest starting investigations after 6-12 months.

There are some basic tests that the doctor may undertake or order immediately:

The sperm test – the man

This is a relatively straight forward test which involves the man providing a semen sample which is tested for

• the number of sperm – this should be around 40 million per sample.
• the motility of the sperm – the sperm need to be capable of moving to the egg to fertilise it.

(It will not look for antibodies in the sperm at this stage. It is controversial as to whether this is relevant to fertility and there is no known treatment for it.)

One in ten men will need to repeat the test, usually 3 months later, as the results can show a poor sample initially, but normal results on a second sample. Two out of one hundred men will have an abnormal sperm sample on a second test and further investigations will be offered.

Hormone levels to indicate whether you are ovulating – the woman

If you have regular periods (every 26-36 days) then it is highly likely that you are ovulating.

If you have been trying to get pregnant for one year, or you have irregular or no periods, then you will be offered blood tests to measure your hormone levels, which indicate whether you are ovulating.

Progesterone is released after you have ovulated (released an egg) – if you have a regular cycle, a blood test can be performed 3 weeks after your last menstrual period to detect the presence of the progesterone hormone.

Gonadotrophinsstimulate the body to release an egg. There are 2 gonadotrophins called

• Follicle Stimulating Hormone (FSH)
• Luteinising Stimulating Hormone (LSH)

These hormones should be at normal levels during your reproductive years. Low and high levels can indicate that there is a problem.

At this stage you will only be offered other blood tests if you have specific symptoms, for example if it is possible that you may have thyroid problems.

Investigations of the fallopian tubes – the woman

These should not be undertaken until the above 2 tests have been carried out and the results obtained as they are more involved.

They should be done after an infection screen to check for clamydia, which could damage your fallopian tubes and would need treating with antibiotics.

There are two alternatives, both of which work well –

• Hysterosalpingogram (HSG) is an X ray of the fallopian tubes, using a dye which is inserted through the cervix, via the vagina. This enables your specialist to observe whether there are any blockages.
• Hysterosalpingo-contrast-sonography is a detailed ultrasound scan of your fallopian tubes.

However, if you have a history of –

• endometriosis,
• pelvic inflammatory disease or
• an ectopic pregnancy

– you may be offered a laparoscopy. This is an operation under general anaesthetic which enables the doctor to look at your womb and fallopian tubes, through a special telescope and observe any blockages, when a dye is inserted into the cervix.

Although other tests are available, they should not be offered unless there is a good reason.

Investigating infertility can be daunting and stressful, as an individual and as a couple. There is a great deal of support and counselling available, which it is advisable to use sooner rather than later – talking to couples in a similar situation can be most valuable. Both of you may be under a great strain whilst you discover whether there is a problem with both or either of you in conceiving a child. Ensure that you feel comfortable with the professional staff involved in your care and that all procedures are well explained to you.

Useful articles

For more information on Increasing Your Chances of Getting Pregnant, visit our friendly and informative article.

There are many Causes of Infertility amongst men and women – click here for an overview of the most common problems.