If you're found to have a fertility problem, or initial tests suggest there may be one, the next step is to see a specialist who'll try to find a cause. There are some specific tests that all specialists will carry out and others that may be advised.
For women, the basic tests include:
For men, the basic tests include:
If there are no sperm or the sperm count is very low, this test should be repeated, generally within three months. About one in ten men has an abnormal sperm result on initial testing.
That is done in order to check if the fallopian tubes are blocked. A dye is injected through the neck of the womb. As it fills the womb cavity and travels into the fallopian tubes, it is viewed by x-ray.
The doctor makes a small incision near the navel and inserts a small telescope (a laparoscope) to allow him or her to inspect the womb and fallopian tubes. A dye can be injected through the cervix to see if it runs through the fallopian tubes (laparoscopy and dye). With Laparoscopy we can also check for scar tissue, endometriosis or blockage of the fallopian tubes. A laparoscopy is usually offered if you've had pelvic inflammatory disease, endometriosis or an ectopic pregnancy.
We can check for fibroids, polyps or any other abnormalities. A small microscope, called a hysteroscope, with a camera attached is passed through the vagina and cervix to view the womb.
The results of the tests should give the doctor a clearer idea of what's causing the infertility and where the difficulty lies. At a follow-up appointment, he will explain what the results mean and discuss any possible treatment options.
Fertility treatment is a highly individualised affair and any decisions will depend on your particular circumstances. For example, a couple in their 20s where the female partner appears to have no problem but the man has a low sperm count may decide to continue trying for a while without treatment because time is on their side. However, a woman in her late 30s in the same situation may want to consider opting for treatment sooner rather than later because of the natural age-related decline in female fertility.
A good relationship with the team at the doctor is vital to help reach the best decision. It's important to feel comfortable asking questions until you have enough information to make a decision.