If you have been unable to conceive naturally for a year, do not waste any time
Arrange an appointment to speak to your doctor and get started with the all important tests that will get to the bottom as to why you are not conceiving. There may be an underlying issue that needs to be resolved and is preventing pregnancy.
You can start these initial tests with your local GP/OBGYN/doctor or you can get in touch straight away with a private clinic. If you are in the UK and eligible for IVF on the NHS, your GP will refer you to a fertility clinic if necessary.
So what happens first?
The first stage: preliminary chat with your doctor
Your doctor will ask you questions about your general wellness. They will ask you about your lifestyle (do you smoke or drink, are you stressed, are you eating a healthy diet, are you overweight?). They will ask you about your medical and sexual history. They will ask you how long you have been trying to conceive.
After this initial chat, your doctor may do a physical examination or refer you for preliminary tests at a fertility clinic.
If you are not eligible for free treatment (if you are in the UK may be eligible for IVF on the NHS) you will need to choose a fertility clinic that is right for you.
Once you have spoken with your chosen clinic, you will be called in for preliminary tests
Preliminary tests will look at the way the ovaries function and that ovulation occurs with no problems.
AMH test (anti-Müllerian hormone). By testing this hormone (with a blood test), it gives the doctor an approximate idea of the amount of viable eggs left in the ovaries of a patient.
Antral follicle – a transvaginal ultrasound that allows your doctor to visually count the number of active egg-containing follicles that are developing on both of your ovaries. With this count, your doctor is able to estimate your total egg count.
There will also be a semen analysis and screening for infectious diseases – HIV, Hep B, Hep C, Chlamydia, and Rubella.
Sexually transmitted diseases can affect fertility and some don’t reveal any symptoms, such as chlamydia. Cystitis and thrush may also cause problems, so make sure you and your partner are tested so you can cross this off the list.
Further tests will help your doctor check to see if there aren’t any reasons for concern, such as cysts, pcos, polyps, fibroids etc
Further tests may include:
Ultrasound scan -to check for cysts in the ovaries, fluid within in the fallopian tubes (hydrosalpinges), fibroids in the wall of the uterus, or polyps within the cavity of the uterus.
HyCoSy – an ultrasound scan, used to check the uterus and fallopian tubes. The examination is done by injecting a foamy contrast agent with hypoallergenic action into the uterine cavity and by performing ultrasound monitoring in real-time of the flow of the contrast through the fallopian tubes. If the ultrasound shows that you have a possible blockage, you may be advised to have a laparoscopy.
Laparoscopy – During a laparoscopy, a laparoscope is inserted into the abdomen via a small incision inside your navel. This allows the specialist to see your fallopian tubes clearly on a screen and make the appropriate diagnosis.
Following these initial tests, you will then have a consultation to discuss your results and course of action
The results of these tests will determine what treatment you are offered.
The 3 main types of fertility treatment are:
Medicines – to encourage ovulation.
Surgical procedures – for blocked fallopian tubes, to break up scar tissue, for removing cysts and fibroids, or for correcting blockages in the testicles.
Assisted conception – this may be either IUI (intrauterine insemination), IVF (in vitro fertilisation) or ICSI (intra-cytoplasmic sperm injection).
Before you begin your treatment, you will have another appointment to discuss in more detail your protocol (treatment plan). The nursing team will talk you through your medication, when to take it, and how to administer injections (if IVF is the route for you).
You will also then sign the necessary consent forms and pay for your treatment.
The next stage will then be the start of your treatment
If you haven’t yet chosen a clinic, take a look at this article: