When a couple first comes to see a gynaecologist with infertility, we 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 menses 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 3 days of abstinence, 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 (x-ray) department so you are awake. It involves a procedure similar to the taking of a pap smear. A dye is injected into your uterus and over the next minute or so, it makes it's way through the fallopian tubes and demonstrates whether these are patent (open) or blocked. The whole procedure takes less than five minutes and involves no surgery.

A laparoscopy on the other hand is a surgical procedure done under a general anaesthetic. A telescope (laparoscope) is inserted into your abdomen through a small cut at the umbilicus and the doctor can directly see the tubes, ovaries and pelvis. Any small problems encountered can be dealt with immediately. There are advantages to each procedure but the most complete assessment can only be obtained through a laparoscope.

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!