When a couple with an infertility problem first visits a gynaecologist, the doctor will need to assess the situation and decide where the problem may lie. Your doctor will initially go through with the history, checking relevant details such as regularity of menstrual cycles, previous pelvic infections or operations, frequency of intercourse (sex) etc. A gynaecological examination is next to pick up any abnormality.
Subsequently both partners will be tested to check their respective fertility. As a guide, approx 40% of problems will relate to the male partner, 40% to the female, 15 will be unexplained (i.e. 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. Sometimes it can feel as though the tests are taking ages to complete and patients can get frustrated. With a little planning, there is no reason why this should be the case as all these can be completed within one menstrual cycle (approx one month).
Most fertility specialists start with an ultrasound scan of the pelvis (internal organs) 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 us 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 e.g. 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.
There are advantages & disadvantages to each procedure and your doctor will recommend the one most suitable for you.
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 you’re ready to commence on your road to a baby!