Diagnosis
About 85% of couples conceive naturally after one year of unprotected sexual intercourse, so if you have not conceived after one year, you should visit your GP.
If you are worried about your fertility, or you are a woman over the age of 35, then you should visit your GP sooner. 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 give you advice about what to do next, and will also carry out an initial assessment to look for factors that may be causing your fertility problems.
It is always best for both partners to visit their GP because fertility problems can be caused by a male or female or, in some cases, both. The process of trying to conceive can be a very emotional one, and it is important that you try and support one another, as stress is just one of the many factors that can affect fertility.
Medical, sexual and social history
When you visit your GP, they will carry out a full medical, sexual and social history in order to identify any possible factors which may be causing fertility problems. Your GP may discuss the following with you:
- Children - your GP will ask a woman if she has given birth previously and will enquire as to whether there were any complications with the pregnancy. They will also ask about any miscarriages. The man will also be asked about whether or not he has had any children from previous relationships.
- Length of time trying to conceive - if you are young, and in good general health, it is likely that you will be able to conceive naturally. 95% of couples are able to conceive naturally after two years of having unprotected sex. If you have not been trying for a baby for very long, you may be advised to keep trying for a little longer.
- Sex - you may feel uncomfortable, or embarrassed, about discussing your sex life with your GP. However, it is very important to be honest and open about this because the problem can sometimes be difficulty with sex which can be easily overcome.
- Length of time since stopping contraception - your GP will consider the type of contraception you were previously using to see whether it may be affecting your ability to conceive. Sometimes, it can take a while for certain types of contraception to stop working.
- Medication - the side effects of some medication can affect fertility. Your GP will therefore look at any medication you are taking and might discuss alternative treatments with you. You should inform your GP about any non-prescription medication that you are taking, including any herbal medicines.
- Lifestyle - smoking, weight, alcohol consumption and stress can all affect fertility, so your GP may discuss ways that you could improve your lifestyle, and therefore increase your chance of conceiving.
After taking a medical, sexual and social history, your GP may conduct a physical examination, or refer you for further tests.
Women
When carrying out a physical examination, your GP may:
- weigh you to see you if you have a healthy body mass index (BMI) for your height and build,
- examine your pelvic area to check for vaginal infection, or tenderness, which could be an indication of endometriosis, or pelvic inflammatory disease (PID) - see causes section.
After your GP has considered your medical history, and carried out a physical examination, they may refer you for further tests and procedures, as outlined below.
- Pelvic ultrasound - uses high frequency sound waves to create an image of an organ in your body, in this case an image of your womb and ovaries.
- Progesterone test - this blood test checks to see if you are ovulating. The test should be taken seven days before you expect a period.
- Chlamydia test - chlamydia can affect fertility. If you have chlamydia, your GP will be able to prescribe antibiotics to treat it.
- Thyroid function test - it is estimated that between 1.3-5.1% of infertile women have an abnormal thyroid.
- Hysterosalpingogram - this is a type of X-ray that checks your fallopian tubes.
- Laparoscopy - a small cut is made in your lower abdomen and a thin, tubular microscope, called a laparoscope, is used to look more closely at your womb, fallopian tubes and ovaries. Sometimes, dye is injected into the fallopian tubes through the cervix (entrance to the womb) to highlight any blockages.
Men
During a physical examination your GP may:
- check your testicles for any lumps or deformities, and
- check your penis to look at its shape and structure and to look for any abnormalities.
Further testing can include:
- Semen analysis - your semen will be tested to see if you have a low sperm count, low sperm mobility, or abnormal sperm.
- Chlamydia test - chlamydia can affect fertility. If you have chlamydia then your GP will prescribe antibiotics to treat it.