Today’s post is about what happens at the start of fertility investigations: perhaps you were hoping to be pregnant by now and you're not or you might already know that you need fertility treatment due to personal or health circumstances - so what are the next steps?
For an otherwise healthy, heterosexual couple when the woman is under the age of 36, the current advice is to visit your GP after you’ve been trying to get pregnant for a year. For those over the age of 36, this reduces to 6 months because research tells us that a woman’s fertility starts to decline in her mid-thirties. It’s important for both of you to get tested, because men and women are equally likely to have fertility issues – and in some couples, both will. If you have any reason to suspect there’s a problem or you know you will need help, go sooner and if you’re a woman who’s been trying artificial insemination for at least 6 months (either partner or donor sperm), with no known fertility issues and no success, the advice is to get further clinical assessment.
Please know though, that you are absolutely not alone because fertility issues are common and they can affect anyone – even if you already have a child. I know this doesn’t make everything ok, but it can help to know there are others out there, going through the same thing.
Your GP will ask about your lifestyle (smoking and drinking habits, work/life balance etc), general fertility awareness and if you are on any medication and check your BMI (body mass index): there may be things you can do to optimise your fertility, like raising or lowering your BMI or reducing your alcohol intake. This doesn't mean you can never drink a glass of wine again, just be sensible and do what feels right for you: a consultant said to me at the time, ‘The guidelines are there for a reason – but it’s really important not to stop living your life either.’
You might have a physical examination and if nothing else seems to be impacting your chances, the next step is to do some blood tests. N.B. You may or may not be referred to a fertility clinic or specialist at this point, but it is always worth seeing if your GP can arrange these tests first, because you should be able to get them through the NHS.
The tests can vary depending on who is carrying them out and where, but the basics a woman will need are as follows:
- FSH (follicle stimulating hormone, LH (luteinising hormone) and oestradiol (the latter can also sometimes identify possible early menopause). These are all tested during your period to check for imbalances.
- Progesterone – to give an indication of whether you are ovulating or not and is taken about 7 days before your period is due
- TSH (thyroid) – a hormone which can affect your fertility
- Chlamydia (this could be a swab or a urine test) – an STI which can affect your fertility
If you have a history of miscarriage, you may have further blood tests, such as lupus anticoagulant and anti-cardiolipin antibodies.
Men will need:
- Semen analysis
- Chlamydia test
What might the results tell me?
Although blood tests don’t always show a complete picture on their own, they can often give an indication of what might be going on, or where to look next. They could tell you, for example, that it’s possible you’re not ovulating or that you might have polycystic ovarian syndrome (PCOS). Conditions such as endometriosis might have been uncovered previously or there may be a combination of problems. It will also indicate whether there are any issues with sperm, such as count.
Sometimes, nothing is unearthed during early investigations and for some couples, this continues throughout treatment: unexplained fertility is relatively common (10-20%). Even if this is the case, and as frustrating as it can be, you will have learned something new: you now have some valuable data about your body. Every new bit of information is something, because it takes you a step further forward. If test results aren’t as they should be, now is the time to find out as much as you can from your GP/RE/Specialist and the internet (I am going to do a post on Dr Google shortly).
The next stage will often be a referral to a fertility clinic or specialist, if this hasn’t been done already. You might be feeling many things by this point - there are no rules. But rest assured, that whatever you are feeling - be it overwhelmed, angry, upset, worried, scared, all of the above, or even relief – is entirely normal. If there are lifestyle changes you need to make, this is probably you first port of call, and many clinics have eligibility criteria (particularly when NHS funding is concerned) around things such as smoking and BMI – you may decide you want some additional support with this.
Tests and referrals can feel like they are taking endless amounts of time (and sometimes they really do) but there are a number of things you can do, whilst you wait:
- Keep on top of your GP/the clinic or specialist about your referral. You can avoid any mismatch in expectations by checking how long the process is likely to take…and then chasing, if it’s not forthcoming
- Research all you can about your situation
- Look at your support networks – and use them
- Keep talking to your partner (if you have one).
Part 2 to follow...I'd love to hear from you in the meantime: what's your experience been so far?