What is normal fertility?
It can be much harder to get pregnant than you may think: in fact, only 20% of couples (who have both eggs and sperm) who are trying to get pregnant do so, for each month of trying. Around 50% are pregnant within 6 months, and 85% by 12 months. Generally speaking, as both eggs and sperm get older, the success rates each month decline. There are many, many reasons why people don’t get pregnant easily: there may be something wrong with the eggs or sperm, or (quite frequently) a problem with both. Some people do not have eggs, sperm, and / or a uterus within their relationship, and will need to see a fertility specialist to discuss egg and / or sperm donation, or surrogacy.
The first visit
We know that to make a baby you need healthy eggs, healthy sperm, and a healthy uterus, in a healthy environment. At your first visit, your fertility clinician will spend time asking questions about your general and gynaecological health, to determine if there are any obvious causes for the delay. If you have a partner, they should also attend the appointment.
Investigations are likely to be ordered. These may include:
– Routine pre-pregnancy blood tests
– A pelvic ultrasound which may include a Fallopian tube patency test
– Assessment of ovarian reserve through a blood test called anti-Mullerian Hormone (AMH), or ultrasound measurement of the ovarian follicles
– Genetic carrier screening test
– Semen analysis
– The follow-up visit
At the follow-up visit, your results will be reviewed and a plan made for further investigations or fertility treatment. In some cases a laparoscopy (keyhole surgery) +/- hysteroscopy (procedure to look at the lining of the uterus with a video camera) may be recommended, particularly if there is a high chance of endometriosis, or uterine conditions that could affect fertility.
Frequently asked questions (FAQs)
What can I do to help my fertility?
Being fit and healthy and of normal BMI is important if you are trying to get pregnant. Cigarette smoking and vaping should be stopped well in advance of starting fertility treatments, as these can affect both egg and sperm health. Alcohol should be limited (and preferably stopped). Regular exercise will not only get you fit for pregnancy and beyond, but can also boost mental health. All of these factors are important for both egg and sperm health.
How can I test my fertility?
Fertility involves many factors, thus testing can be complicated. Often the best test is to start trying! Future fertility can be even more difficult to assess (than current fertility), but having a chat with your doctor or a fertility doctor can help to determine if there are any obvious factors that may lessen your chances of success.
What if I need a donor?
Many people need donor eggs and / or sperm, for a variety of reasons. Most people find donors via a fertility clinic, but they can also be found via family and friends. Fertility clinics can facilitate counselling, testing, and sperm or egg quarantine for both known and unknown donors.
When should I see a fertility specialist?
If you are under 35 years old, you should see a fertility specialist once you have been trying to get pregnant for 12 months. If aged over 35 years old, you should seek advice after six months. If you have known gynaecological issues such as endometriosis, polycystic ovarian syndrome, or have very heavy, painful and / or infrequent periods, you should seek advice earlier.
What fertility treatments are available?
Seeing a fertility specialist does not always mean you will need to do IVF. After hearing your story and performing investigations, your fertility doctor will help you determine the best way forward. Treatments can be as simple as advice regarding timing of sex, or tracking your menstrual cycle with ultrasound and blood tests (to determine when ovulation occurs). Patients with infrequent periods may need medication to encourage ovulation. More advanced treatments such as intrauterine insemination or in vitro fertilisation (IVF) may be recommended.
Where to get good information
The internet is full of “good advice” and can be overwhelming when trying to find quality information regarding fertility. Below are some useful links: