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If you’re concerned about infertility, the best thing to do is to make an appointment with a doctor, preferably an infertility specialist. He or she will start by talking with you and your partner about your medical health and habits. Although you may find some of the questions awkward or embarrassing, it’s the best way to evaluate what might be causing your trouble. In many cases, infertility is the result of a combination of problems, sometimes in each partner, which makes a thorough examination important.

 

1/ Female blood tests – Hormones level

           

            a/On day 3 of your cycle  

Follicle stimulating hormone (FSH)

If too low, this prevents follicle recruitment.

If too high, this may indicate diminished ovarian response (FSH rises with age).

 

Luteinizing hormone  (LH)

An LH that is higher than FSH is an indication of possible PCOS.

 

Prolactin

Prolactin stimulates breast milk production and inhibits FSH.

 

Oestrogen

Raised oestrogen (estrodiol) can indicate diminished ovarian reserve, or possible presence of a cyst.

 

Progesterone

An elevated level on day 3 indicates a lower pregnancy rate (progesterone failing to diminish and rise at correct time during the cycle).

 

Insulin

Excess insulin increases the production of androgens.

High levels of insulin cause the ovaries to overproduce testosterone, interfering with the development of the follicles.

 

Thyroid stimulating hormone (TSH)

Hypothyroidism can have an effect on fertility as it upsets the general hormone balance.

 

            b/On day 21 of your cycle

Progesterone

Without sufficient progesterone to support the endometrium, the embryo will miscarry.

 

            c/Any day of your cycle

Anti-Mullerian Hormone (AMH)

Produce by ovarian follicles, AMH gives an indication of ovarian reserve – the quantity but not the quality of the remaining egg supply.

Often interpreted alongside an Antral Follicle Count (AFC).

 

2/Uterine tests

 

Laparoscopy

A surgical procedure in which the abdomen is inflated with gaz and a fibre-optic instrument is inserted through the abdominal wall  to view the uterus and other organs.

Done under general anaesthetic, it may include surgery to remove endometrial tissue, adhesions, etc…

 

HyCoSy

(Ultrasound with hysterosalpingo contrast Sonography)

Sugar water is injected into the uterus and fallopian tubes are checked for blockages.

Ultrasound examination avoids the use of X-rays.

 

Hysteroscopy

The inside of the womb is inspected by a miniature telescope in a narrow tube; biopsy or removal of a polyp may happen at the same time if necessary.

Local anaesthetic only.

 

Transvaginal ultrasound

Type of pelvic ultrasound used to look at the uterus, ovaries, cervix, and vagina

May show up conditions such as

-Bicornuate (bicornate) uterus, a malformation where the uterus spilts into two “horns” at the upper part; associated with recurrent miscarriage, preterm birth and breech presentations

-retroverted (tilted) uterus , where the uterus is tilted backwards instead of forwards. Possibly 20% of woman have this. No impact on fertility. Becoming pregnant frequently realigns the uterus correctly

 

Antral Follicle Count (AFC)

Antral follicles are visible by vaginal ultrasound

Scanning on day 2 to 5 of the cycle. It shows the number of eggs in the process of developing (the number of follicles), enabling ovarian reserve to be predicted

 

3/ Others tests

 

Body Mass index

BMI is calculated by dividing the weight in kilograms by the height in metres square

Increased BMI is associated with increased testosterone

BMI above 30: consistent with hyperinsulinaemia ( metabolic syndrome), a feature of obese women with PCOS

BMI below 19: typically results in reduced hormone levels, sub fertility and the risk of pregnancy complications such as miscarriage and low birth weight

 

Sexually Transmitted Diseases  (STDs)

Such as Chlamydia: Often asymptomatic, it can damage the fallopian tubes

 

 

Semen Analysis (Sperm Test)

Evaluates certain characteristics of a male’s semen and sperm such as sperm count, motility, morphology, volume, liquefaction

 

 

Chromosomal Testing

Of both partners, to screen for genetic defects

Done on the NHS only after three consecutive miscarriages