Investigating infertility

What happens when your doctor decides to start investigating why you’re not conceiving

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If you’ve been trying to conceive for more than a year, or six months if you’re over 35, your doctor should be open to helping you start investigations to see if there is a problem. Read on to find out what this could involve.

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Getting started

Your doctor may be able to start elementary investigations at the surgery, or she may refer you to a local hospital, gynaecologist or fertility clinic for tests. It’s a good idea to see the doctor together so 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. 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 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.

Your doctor may start with recommendations for optimising your chances of conception by addressing potential problems with your diet and lifestyle. If she 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.

Fertility test results

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 necessarily prevent you from getting pregnant in time. Your 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 (such as complete anovulation – absence of ovulation– a zero sperm count or blockage of tubes) that will stop you getting 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.

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.

There may also be a question of whether you’re entitled to fertility testing and/or treatment on the NHS, as it may be restricted to married couples 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.

If you can afford to pay for some treatment in some areas it may be possible to effectively ‘jump’ the NHS waiting list by paying a fee. The treatment here will be exactly the same as the usual NHS treatment and will usually be significantly cheaper than private treatment. While you may have qualms about paying to get ahead, on the positive side you’ll 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 worth asking whether this is the case as it can help you avoid a long waiting list at relatively low cost.

Going private

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 or fertility testing.

Private testing and treatment can be 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

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Given the potential expense, it’s worth checking what the NHS offers in your area first. If you’re 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.

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