Any couple trying for a baby can tell you that infertility can be one of the deepest concerns any two people can face together. If you’re on this difficult journey, you may be unsure about what steps to take, and where to start tackling the issue from.
While your doctor should be your first port of call, I wrote this guide to help you understand what tests you might be asked to take and what you might expect to experience along the investigative journey. Because I come from a medical background, I can appreciate the fact that there is conflicting information on the internet on various tests which leaves most people more confused than not when attending the hospital for an appointment. My aim in this guide is to highlight the importance of these tests and help you understand the process – so forgive me if this is a bit long. You may also notice that I have included links to mostly UK health information pages. The reason for this is that because the UK health system is free at the point of entry, it means that the National Health Service wants all tests done at the highest standards and at the most effective cost. In fact, there is a body which effectively manages this. This means that UK-based doctors tend to have a system of vetting tests and procedures to eliminate anything which might be deemed “unnecessary”, and this guide will only feature tests proven to have the highest, research-backed clinical benefits to you.
When to see a doctor
Statistics show that 20% of couples where a woman is under 40 will not conceive within a year of having regular, unprotected sex. You can see a fertility specialist if
- you have tried for a year without success
- you are female, and are aged 36 and over, as fertility starts to decline after age 35
- you have any reason to be concerned about your fertility such as previous cancer treatment, mumps as a child, sexually transmitted infections in the past etc.
More often than not, it is usually the case that the cause of a couple’s infertility is down to more than one specific factor so it is best for both partners to visit the specialist together. The fertility specialist practitioner will usually collect a full medical history, asking questions about previous births, complications, whether you smoke / drink / use drugs, if you are stressed, previous contraception use, miscarriages, previous STIs and also children from previous relationships. The doctor may also check your weight – it may be that there could be some lifestyle changes you could make to help you conceive naturally, and without resorting to expensive IVF cycles.
Fertility checks for men
If you are a man, your doctor may check your:
- testicles to look for any lumps or deformities
- penis to look at its shape, structure and any obvious abnormalities
Following this, he/she might recommend that you carry out the following tests
- Semen Analysis: The doctor will collect a sample of your semen in a sterilized container and send it to the laboratory for tests measuring the sperm count and examining for abnormalities in the shape and movement of your sperm and signs of infections. Oftentimes, more than one semen analysis will be required to get accurate results as sperm count fluctuates.
- Chlamydia test: A sample of your urine will be tested to check for chlamydia, as it can affect fertility.
- Scrotal Ultrasound: An ultrasound machine is used to look at your scrotum. The test works just as a pregnancy ultrasound as your doctor is able to see possible problems in your testicles such as a varicocele – a swelling of the veins in the scrotum which requires surgical correction.
- Post-Ejaculation Urinalysis: Usually, when sperm is present in your urine, it signifies a retrograde ejaculation whereby your sperm swims backwards into the bladder rather than out of your penis during ejaculation.
- Genetic Tests: Low sperm concentration could be sometimes caused by genetics. A blood test is usually run to show if there are slight changes in the Y chromosome.
- Specialized Sperm Function Tests: Tests are run to reveal the longevity of your sperm after ejaculation, their ability to penetrate an egg and any problems in attaching to an egg.
- Other Tests: In select cases, some other testing will be required to properly evaluate a semen sample. Tests will be conducted to reveal potential DNA abnormalities and ascertain the quality of the sperm.
Fertility tests for women
A woman’s fertility relies on multiple factors including healthy eggs, free passage of eggs through the fallopian tubes, and access of fertilized eggs to the uterus. The need to see a doctor is higher in women over 36 as fertility declines as a woman goes past her mid 30’s. As with your partner, the doctor will begin by familiarizing himself/herself with your sexual and medical history which may include very personal and uncomfortable questions. However uncomfortable these questions get, it is best to answer them as honestly as you can as this will help the doctor ascertain a likely cause of your problems in conceiving. Your doctor may carry out physical tests and examinations after this.
- Physical Examination: Your doctor may check if you have a healthy and suitable BMI (Body Mass Index) by weighing you and then examine your pelvis for lumps and tender spots which could be signs of fibroids or ovarian tumours.
- Blood Tests: To check if you are ovulating, a sample of your blood will be tested for progesterone. If your periods are irregular, your gonadotrophins (hormones which stimulate egg production in the ovaries) will be measured.
- Chlamydia Test: A sexually transmitted infection that can affect fertility is Chlamydia. For the test, your doctor will collect some cells from your cervix with some swabs and tests will be run on them. A urine test can also be used for diagnosis and antibiotics will be prescribed if you have Chlamydia.
- Ovarian Reserve Testing: The doctor will try to determine the quantity and quality of your eggs, their over-all health and availability for ovulation. A hormone test is usually run first when the menstrual cycle begins.
- HSG (Hysterosalpingogram): This is an X-ray procedure where a special dye is injected into your womb and fallopian tubes. The doctor will perform x-rays while injecting the dye and if there is a blockage, the dye highlights where the blockage is. Sometimes, when the dye is pushed back, it could also push back the blockage, and this could cure the problem
- Ultrasound Scan: Conditions that affect the womb like fibroids and endometriosis can prevent pregnancy. Your doctor may run an ultrasound scan to examine your womb, ovaries and fallopian tubes. The fallopian tubes may be blocked, causing your eggs being unable to travel into the womb.
- Laparoscopy: If your doctor discovers a blockage in your fallopian tubes, a small incision will be made in your lower stomach and a tube with a camera attached to the tip is inserted to examine the womb and fallopian tubes. This test is however, rarely needed and is only minimally invasive.
- Other Hormone Testing: The doctor might need to run some other tests checking some of your hormone levels like your ovulatory hormones and pituitary hormones as these hormones play a vital part in the reproduction process.
When tests are conducted and both partners are thoroughly examined, the doctor may ascertain a definite cause of their infertility and prescribe drugs, changes in lifestyle or whatever else he/she deems best to help. Sometimes, cases of infertility can’t be corrected and the best option may be surrogacy or adoption and both partners will have to come to terms with that. The main thing to remember is not to stress and worry too much over your infertility, stress is amongst the top contributors to problems in conceiving.