Investigating infertility - where to start
Do you have a fertility problem, when should you seek help and are you doing everything you can to try to conceive?
Knowing when to seek help
Once you have been trying to conceive for over twelve months, or six months if you are over 35, your doctor should be open to helping you start investigations into whether there is a problem, and what it might be. If necessary, your doctor may be able to start basic investigations at the surgery, or she may refer you to a local hospital, gynaecologist or fertility clinic for tests. As any problem may lie with either partner, or with both, it's a good idea to see the doctor together so he or she can get a good picture of your overall health as a couple and perhaps pick up on any obvious issues that may affect your combined fertility.
When you first see your doctor about fertility issues it can help greatly, and save not only time, but money, if you're well prepared with all the relevant information you can provide. For example, if you've been charting your fertility signs for several cycles then you may be able to provide useful evidence and clues to what's happening, such as whether or not you're ovulating. Your doctor will probably ask plenty of questions about the health of both partners, including about your diet, lifestyle, work and sex life. You'll probably also be asked about what birth control you have used and the history of any previous pregnancies and illnesses. The more accurately you can answer all these questions, the better the doctor will be able to help you.
Diet and lifestyle
Your doctor may start with recommendations for optimising your chances of conception by addressing potential problems with your diet and lifestyle and so on (you can read up on what the most common causes of infertility are and how to optimise your chances of conception). Take a look at our conception checklist before you book your appointment. If the doctor can't identify any immediately obvious causes of infertility, or if the consultation points in a particular direction then you may have initial tests through the surgery or be referred to a specialist.
Availability on the NHS
The extent of investigations and treatment for infertility available on the NHS varies from area to area, as do the lengths of the waiting lists, so this is one of the things it's worth establishing with your doctor at the outset. There may also be a question of whether, as a couple, you're entitled to fertility testing and/or treatment on the NHS. For example in areas where IVF treatment is available it may be restricted to couples who are married and under a certain age limit.
If your doctor is able to conduct initial tests and treatment through the surgery then it's a good idea to check what sort of costs may be involved for you, such as the cost of any prescribed fertility drugs.
More like this
If the treatment available on the NHS is good in your area, then the waiting list is often a significant set-back, particularly for couples who are a bit older. If you are able to afford to pay for some treatment it's worth knowing that in some areas it may be possible to effectively 'jump' the NHS waiting list by paying a fee. Apart from not needing to wait, the service you receive the treatment here will be exactly the same as the usual NHS treatment. This will usually be significantly cheaper than private treatment and, while you may have qualms about paying to get ahead, on the positive side you will be contributing to NHS coffers which will be beneficial to others.
For fertility drug treatment the choice may not be a private-NHS one. In some cases your GP may agree to the surgery bearing the cost of fertility drugs prescribed by a private specialist, though not the cost of the consultation itself. It's well worth asking whether this is the case as it can help you avoid a long waiting list at relatively low cost.
If you're considering private treatment your doctor will probably be able to tell you which the specialist private clinics in your area are, and may even be able to make recommendations. If you're already privately insured then you'll need to check what fertility investigations and treatment your insurance covers: many health policies don't cover fertility treatments and some don't even cover fertility testing.
Private testing and treatment can end up being very expensive, particularly if treatments such as IVF and donor schemes are involved, and once you've embarked on the road of treatment it's easy to get caught up in a repeated cycle of tests and treatments. If you are going to use private treatment then it's a good idea to set a budget for yourselves at the outset. Even if you don't stick to it strictly, it can serve as a useful reality-check down the line.
Given the potential expense involved with private treatment it's well worth checking what the NHS offers in your area first. If you are having initial tests on the NHS and considering private treatment afterwards, then it's worth finding out whether the clinics you're considering accept the results of tests conducted elsewhere, as many do not and you may have to run through elementary tests again, at a cost.
Where investigations may lead you
Following one or several tests several different outcomes are possible:
• Lower fertility - You may be told that one or other of you has a medical condition - such as lower than normal sperm count, irregular ovulation, PCOS, fibroids - which does lower your combined fertility but will not neceessarily prevent you from getting pregnant in time. In this case the choice will be whether to keep trying for a while (you may be able to take steps to optimise your chances of conception) or to have treatment for the condition
• Infertility - There may be a more significant problem diagnosed (such as complete anovulation, a zero sperm count or blockage of tubes) that will prevent you from becoming pregnant unless you receive treatment. The treatment options will be laid out and you can decide whether or not you want to go ahead, and how
• Unexplained infertility - The tests may not reveal any reason for your difficulties conceiving, which doesn't necessarily mean that there isn't a problem. In this case doctors won't be able to tell you whether you're likely to conceive with time or not. This doesn't mean that you don't have any treatment options however, treatment such as intrauterine insemination or IVF may be effective.
In many cases, once identified, a cause of infertility (or lower fertility) can be treated successfully with drug therapy, for example to prompt the production of healthy sperm, to induce ovulation or to clear up an infection. However, depending on what the cause of infertility is, other treatment may be recommended, such as surgery, intrauterine insemination, IFV, GIFT and so on. If more invasive, and costly, treatment is recommended, it may be useful to seek help from a counsellor in weighing up the pros and cons of treatment as a couple, and in taking a decision to which you're both committed.
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