Infertility - Diagnosing infertility

Around 84% of couples conceive naturally within one year of having regular (every two to three days) unprotected sexual intercourse. You should visit your GP if you have not conceived after one year of trying.

You should visit your GP sooner if:

• you have any reason to be concerned about your fertility – for example, if you have had treatment for cancer
• you are a woman aged 36 and over

Fertility testing and investigation can be a lengthy process, and female fertility decreases with age, so it is best to make an appointment early on.

Your GP will be able to advise about what to do next, and carry out an initial assessment to investigate things that may be causing your fertility problems.

It is always best for both partners to visit their GP, because fertility problems can affect a man or a woman, and sometimes both partners.

The process of trying to conceive can be an emotional one, so it is important to support each other as much as possible. Stress is just one of the things that can affect fertility.

Medical, sexual and social history

When you visit your GP, they will want to discuss your full medical, sexual and social history. This will help them identify what may be causing fertility problems.

Age

Fertility in women declines with age, and your GP can discuss this with you.

Children

If you are a woman, your GP will want to discuss any previous births and any related complications with your pregnancy. They will also ask about any miscarriages you may have had.

If you are a man, you will be asked whether you have had any children from previous relationships.

Length of time trying to conceive

Your GP will ask how long you have been trying to conceive. A study has found that couples having regular unprotected sex:

• aged 19-26 – 92% will conceive after one year and 98% after two years
• aged 35-39 – 82% will conceive after one year and 90% after two years

If you are young and healthy, and you have not been trying for a baby for very long, you may be advised to keep trying for a little longer.

Sex

You will be asked how often you have sex, and whether you have any difficulties during sex. You may feel uncomfortable or embarrassed about discussing your sex life with your GP. However, it is very important to be open and honest. If the fertility problem is to do with sex, it might be overcome easily.

Length of time since stopping contraception

You will be asked about the type of contraception you previously used, and when you stopped using it. It can sometimes take a while for certain types of contraception to stop working, and this may be affecting your fertility.

Medical history and symptoms

Your GP will want to discuss any medical conditions you have, or have had in the past, including sexually transmitted infections (STIs). If you are a woman, your GP may ask how regular your periods are and whether you experience any bleeding between periods or after sex.

Medication

The side effects of some medications can affect your fertility. Your GP will look at any medication you are taking, and might discuss alternative treatments with you. You should mention any non-prescription medication you are taking, including herbal medicines.

Lifestyle

Several lifestyle factors can affect your fertility. Your GP will want to know:

• if you smoke
• how much you weigh
• how much alcohol you drink
• whether you take any illegal drugs
• if you are stressed

They may recommend changes to your lifestyle to increase your chances of conceiving. Read more about preventing infertility.

After taking a medical, sexual and social history, your GP may carry out a physical examination, or refer you for tests.

During a physical examination, your GP may:

• weigh you, to see if you have a healthy body mass index (BMI) for your height and build
• examine your pelvic area, to check for infection, lumps or tenderness, which could be an indication of fibroids, ovarian tumours, endometriosis or pelvic inflammatory disease (PID) (see causes of infertility)

After your medical history and physical examination have been considered, you may be referred to a specialist infertility team at an NHS hospital or fertility clinic for further tests and procedures. These are outlined below.

Tests for women

For women, a number of tests can be used to try and establish the cause of infertility.

Hormone tests

A sample of your blood can be tested for a hormone called progesterone, to check whether you are ovulating. The timing of the test is based on how regular your periods are.

If you have irregular periods, you will be offered a test to measure hormones called gonadotrophins, which stimulate the ovaries to produce eggs.

Checking your ovaries

Your ovaries may be tested before you are offered fertility drugs. This may be either a blood test to measure certain hormones or an ultrasound scan to examine the follicles in your ovaries.

Chlamydia test

Chlamydia is an STI that can affect fertility. A swab (similar to a cotton bud, but smaller, soft and rounded) is used to collect some cells from your cervix to test for chlamydia. If you have chlamydia, you will be prescribed antibiotics to treat it.

Hysterosalpingogram

A hysterosalpingogram is a type of X-ray taken of your womb (uterus) and fallopian tubes after a special dye has been injected. This will outline the cavity of your womb and detect any blockage of the fallopian tubes.

Hysterosalpingo-contrast-ultrasonography

A hysterosalpingo-contrast-ultrasonography is a type of ultrasound scan. A small amount of fluid will be injected into your womb through a tube that is put into your cervix (the womb opening). Ultrasound is used to confirm whether this fluid spills through the tubes. 

Laparoscopy

A laparoscopy involves making a small cut in your lower tummy (abdomen). A thin, tubular telescope called a laparoscope will be used to look more closely at your womb, fallopian tubes and ovaries. Dye may be injected into your fallopian tubes through your cervix to highlight any blockages in them.

A laparoscopy is usually only used if there is a strong chance that you have a problem – for example, if you have had an episode of PID in the past.

Examination and tests for men

During a physical examination, your GP may check:

• your testicles – to look for any lumps or deformities 
• your penis – to look at its shape and structure, and for any obvious abnormalities

Further testing may include:

• a semen analysis – your semen will be tested to determine whether you have a low sperm count, low sperm mobility or abnormal sperm
• a chlamydia test – a sample of your urine will be tested to determine whether you have chlamydia

If you do have chlamydia, your GP will prescribe antibiotics to treat it.