Pursuing medical advice for fertility issues is a tricky thing to do. All you know so far is that you’ve been trying and, for some reason, it hasn’t been working.
So, the very first step you take is to make an appointment with your GP, which will inform what happens next.
It might seem pretty natural to attend with your partner, as a couple, but to begin with both you and your partner should make separate appointments - ideally one straight after the other - as you both need to be tested individually.
When should you see your GP about fertility concerns?
“Whenever you’re worried, you can come and see us,” explains Dr Philippa Kaye, a GP. “But if you’re under 35 we'll only investigate if you’ve been trying for a year by having regular unprotected sex.”
She also notes that investigations start at 6 months into the TTC journey if you’re over 35 - or think there may be a problem for a number of reasons, such as:
- if you’ve ever had pelvic surgery
- you’ve had radiotherapy or chemotherapy
- your partner has had surgery to move his testicles down as a baby
- if you have Polycystic Ovary Syndrome
- you have another similar existing condition or issue.
What questions will I be asked?
For women, once your appointment has begun, the doctor will likely take a history, including detailed info about your periods and whether or not you’ve experienced a pregnancy before.
Dr Kaye shared a few example questions you will likely be asked:
- How old were you when you started your period?
- How long do you bleed for?
- When does your period come?
- Have you ever been pregnant, had a miscarriage or abortion?
- What kind of contraception were you using?
- When did you stop using contraception?
- Have you ever had an STD?
- What’s your past medical history?
- A series of lifestyle questions including queries about smoking and alcohol consumption
For men, the questions differ slightly. They’ll be asked the same lifestyle questions, but they will also be quizzed on whether or not they have any children already (from the same or a different partner) and if they’ve ever had surgery.
What kinds of fertility tests will I have to do?
Whether or not you do all of these tests in your initial appointment, or at a later date, is really up to your GP and depends on how much time you have, says Dr Kaye.
But again, the tests for men and women differ greatly. For women, an examination will take place, which doesn’t for men.
“I would examine, and that means feeling the tummy, and doing an internal vaginal examination, and then doing a spectrum examination to the cervix, taking a swab for STDs,” explains Dr Kaye.
She would then go on to order a pelvic ultrasound and “a barrage of blood tests” – which sounds quite scary, though nothing to freak out about. It’s fairly routine stuff.
“Women have a hepatitis or HIV screening, and then they will need a set of bloods from somewhere between Day 2 and Day 5 of their cycle. Day 1 is the first day of bleeding, so ideally you want some blood from Day 2, but anything between 2 and 5 is fine.”
These tests look out for hormones FSH (follicle-stimulating hormone) and AMH (anti-mullerian hormone, from the ovaries). There’ll also be general function tests, a test of the thyroid function and another test that looks at prolactin (your milk-producing hormone).
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After all that, the hormone tests are repeated at Day 21 of your cycle. “You’ll get 2 different sets of results, depending on when your cycle hits,” explains Dr Kaye. “It must be after 21 days – tests at beginning and end of cycles tell us whether or not you’re ovulating.”
Men, however, will have to provide semen for an analysis and in order to be referred to a fertility clinic, will also need to be tested for hepatitis and HIV.
What happens next?
After all that’s been done, and the results are in, it’s time for you to make an appointment and discuss all the findings. (You need to book the appointment yourself, as they might not ring you to set it up).
And as reassuring as it would be to have a definitive next step on your TTC journey, what comes next really depends on whether or not you need to repeat a test, what your results say and the specifics of your personal situation.
But depending on what your test results DO say, your GP may decide to refer you to a specialist, a clinic, discuss lifestyle changes or one of the many fertility treatment options with you.
It’s a daunting place to be, especially as many people assume IVF will be the only option going forward. But as Dr Kaye says: “Loads of women doesn’t get as far as IVF, and there are lots of things before that.”
In fact there are actually quite a few treatment options out there, and you could be suitable for some of them – and you can learn the basics about the fertility drugs and treatments available here.
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