First Visit and Initial Investigation

Couples should seek help from a fertility specialist if they can’t conceive:

·         after 12 months of trying, if they are less than 30 years of age  

·         after 6 months of trying, if they are between 30-34 years of age

·         after 3 months of trying, if they are 35 years of age or more

When a couple with an infertility problem first visits a gynaecologist or a fertility specialist, the doctor will need to assess the situation and decide where the problem may lie. The doctor will initially go through with the history, checking relevant details such as regularity of menstrual cycles, previous pelvic infections or surgeries, frequency of intercourse, etc. A gynaecological examination is next to pick up any abnormality.

Subsequently both partners will be tested to check their respective fertility. Approximately 40% of problems will relate to the male partner, 40% to the female, 15% will be unexplained (no problem can be found) and the remaining 5% will be miscellaneous rare causes.

 

Basically, to get pregnant you need good sperm, good eggs, a healthy uterus and healthy fallopian tubes, at least one, so the tests are designed to check these. All these tests can be completed within one menstrual cycle, which is around one month.

Most fertility specialists start with an ultrasound scan of the pelvis to directly visualize the uterus and ovaries. Any abnormalities of these will easily be seen and if relevant, be acted upon. This scan is usually performed during the woman’s menstruation, along with a blood test, to assess hormonal imbalances that can contribute to infertility. The combination of these two tests gives the doctor a good idea of the ovarian reserve, a term used to describe her fertility potential.

Subsequently, another ultrasound scan around the time of ovulation may be performed to assess the receptivity of the endometrium (lining of the uterus) to an embryo and exclude any problems that may decrease this such as polyps or fibroids.

At any time, and after 2-5 days of abstinence from sexual intercourse, a check of the husband’s sperm count and quality can be performed.

These three simple tests would have checked the quality of sperm, egg and uterus and can all be completed within the first two weeks of the period.

Now all that is left is a check of the fallopian tubes. This is slightly less easy than the above tests, so it is usually left for last. One of two methods may be suggested, either a hysterosalpingogram (HSG) or a laparoscopy. A hysterosalpingogram is a test done in the radiology department and the patient is awake. It involves a procedure similar to the taking of a pap smear. A dye is injected into the uterus and over the next minute or so, it makes its way through the fallopian tubes and demonstrates whether these are open or blocked. The whole procedure takes less than five minutes and involves no surgery.

 

A laparoscopy is a surgical procedure done under a general anaesthetic. A telescope (laparoscope) is inserted into the patient’s abdomen through a small cut at the navel and the doctor can directly see the tubes, ovaries and pelvis. Any small problems encountered can be dealt with immediately such as ovarian cysts. There are advantages to directly visualising a woman’s reproductive organs, but the necessity for a general anaesthetic, surgery and the associated risks makes this the second choice for most doctors. A hysterosalpingogram (HSG) will often be enough.

 

There are advantages & disadvantages to each procedure and the doctor will recommend the one most suitable for each individual.

Only after the tests are complete can a treatment plan be formulated, but with a little planning, everything can be completed within a month and the couple is ready to commence on their road to a baby!