If you have been trying to conceive for over a year and consult a specialist, your clinician will arrange for you both to undergo a series of tests. Whilst infertility affects both men and women equally, if you have consulted a fertility specialist, you have been trying for 6 months or more and the female partner is over 35, your doctor may recommend investigations immediately. The primary reason for this is that female fertility declines with age and being older than 35 may reduce the chances of natural conception. Early diagnosis and treatment can optimise success.
When you get referred for further investigation, there are a number of different tests you could be asked to undergo by your GP or fertility specialist, and it is natural to have questions. We’re here to help answer some of those questions.
Female tests
Blood tests:
What happens?
- A small sample (about a teaspoon full) of your blood is collected for testing in a short and virtually painless procedure. If you are having regular periods, this sample may be taken early in your cycle (for FSH – Follicle Stimulating Hormone and LH – Luteinising Hormone) or on day 21 of your cycle (for Progesterone).
What are they testing for?
- These samples are used to test for different hormone levels. Day 21 (mid-luteal phase) Progesterone levels are checked to see if you are ovulating. FSH and LH hormones are responsible for developing a follicle within the ovary in which an egg grows each month. These hormone levels can help establish what issues might be responsible for a lack of ovulation or irregular/absent periods. An AMH (Anti-Mullerian Hormone) test is a good indicator of ovarian reserve and gives some indication of how well your ovaries are functioning and whether you are likely to produce enough eggs if fertility treatment should be required.
A raised testosterone level is often seen in women with Polycystic Ovarian Syndrome (PCOS)
The blood sample can also be used to check that you are immune to Rubella (German Measles) and whether you have been in contact with CMV or Chlamydia.
It is important not to get too worried about biochemical results from the lab! The ‘normal range’ for results is often quite wide and there are many other important factors that can impact fertility.
Ultrasound scan
What happens?
- This depends on the type of scan you are going for. An external ultrasound scan of your ovaries and reproductive organs would be exactly like ones which are used to examine a pregnant lady. You will be required to have a full bladder and some gel will be rubbed on your lower stomach and the probe scans the area. If you are having a transvaginal ultrasound, then you will need an empty bladder and a very small probe will be inserted into your vagina to perform the scan. Ultrasound scans can be enhanced with a kind of contrast media using a technique called HyCoSy. This allows for better visualisation of the anatomy of the reproductive tract and can check that the fallopian tubes are not blocked.
What are they testing for?
- Your doctor will be checking your reproductive organs and looking for any potential issues. This includes cysts, endometriosis, fibroids or possible damage to your fallopian tubes. Transvaginal ultrasound scans are usually more focused on your ovaries and fallopian tubes, testing to see if you have a blockage or anomalies.
- If significant issues are found, then your fertility specialist may want to refer you for a laparoscopy. Laparoscopies are not only diagnostic, they can also give an opportunity to treat the underlying problem such as ovarian cycsts, adhesions around the Fallopian tubes or mild endometriosis.
Male tests:
Physical examination/check-up
What happens?
- Your genitals will be examined by your doctor who will also ask you a number of questions regarding your medical history.
What are they testing for?
- Genital exams can help identify a number of issues, which could be affecting your fertility. This includes whether or not you have a varicocele which is a common issue for sub-fertile men. A varicocele is when the veins, in this case within the scrotum, enlarge and this can cause overheating overheating of the testes. Raised temperatures in the scrotal region can cause oxidative stress and harm sperm production. The questions on your medical history can help make the clinic aware of any conditions, injuries, surgery, or health problems which could affect fertility.
Semen analysis
What happens?
You’ll be asked to go to a clinic and give a sperm sample. The clinic usually requests that you observe a ‘period of abstinence’ or time without ejaculating of 2-5 days. Men are often understandably embarrassed at the prospect of ‘producing a sample’ in a strange place. You can be reassured that the clinic staff are totally discreet and professional and the rooms are private and comfortable. If you do not live too far away from the clinic, you may be allowed to produce the sample at home and deliver it.
What are they testing for?
- A semen analysis will check for the basic sperm health parameters. This would be sperm count (number of sperm per ml), morphology (size and shape) and motility (ability to swim in a straight line). All three of these factors are important when considering male fertility. However, often overlooked is the DNA fragmentation test. This tests for the quality of the DNA within the sperm, which is vital for conception. If you are having a semen analysis, it would be a good idea to also have a sperm DNA fragmentation test as well, although this may not be readily available on the NHS.
Men and women: Chlamydia test
It is important that both partners are tested for Chlamydia
What happens?
- You will usually be asked to give a urine sample, but could have a small swab sample from your genitalia
What are they testing for?
- Chlamydia is a sexually transmitted infection (STI) which can negatively affect fertility. If you test positive for this infection, you’ll be prescribed medication to help treat it.
- This is especially important in the female partner, as chlamydia infections can cause pelvic inflammatory disease and damage to the female reproductive tract, including fallopian tube damage.
Results
Your clinician will usually give you a rough idea for when you can expect your results. A lot of conditions are manageable and can be treated with medication, which your doctor will prescribe to you if necessary. Others can be solved with small routine surgical procedures.
Overall fertility can be improved by making small lifestyle changes and supplementing your diet. If you are struggling with irregular periods and anovulation, then you could be diagnosed with PCOS. Inofolic Alpha could help.
If your sperm test includes DNA analysis and you are told you suffer from DNA fragmentation, Impryl has been proven to help. Impryl has also been shown to increase AMH levels in women, which is a good indicator of improved ovarian function.
There are hundreds of testimonials for both Impryl and Inofolic Alpha where you can see how the products have managed to help so many other couples who have been struggling to conceive.
