Seeking fertility advice
First of all, go to see your family doctor so you can talk about your worries and ask any questions. For many couples it's the woman who seeks advice first, but it's really important for you both to accept that whatever the reasons for your problems, you're both going to need investigation. So if at all possible, get things off to a good start and make the first visit a joint one.
If you're worried that your doctor won't have the time for the kind of detailed, relaxed conversation you need, ask for a longer appointment, perhaps at a time of day when things are less pressured. Or you could try going to the sexual health clinic in your local hospital or a family planning clinic. You don't need a referral from your doctor for either of these, and you should find a team of sympathetic experts to talk to.
What will happen before fertility investigation?
When you first see your doctor, ask how any treatment is likely to be managed. Each stage in the investigation and treatment of infertility should be fully explained to you in a way you can understand. You'll also be given lists of self-help organizations to get in touch with. Your family doctor may do the initial tests or may refer you to a specialist. Either way you'll be referred for all secondary tests and for further treatment to a dedicated specialist infertility clinic. You do have the right to insist that you're referred to such a unit.
Any infertility treatment is a stressful business, so it's important that the doctors caring for you are relaxed and friendly. The atmosphere of the clinic should be sympathetic so you feel that you'll be listened to properly. The clinic should also provide information on what will be involved, including the pros and cons of any alternative treatments.
Primary fertility tests
The first tests can be initiated by your family doctor, but many doctors prefer to refer you. Your doctor will ask about your fertility history as a couple, including your ages, how long you've been trying to conceive, past illnesses or surgery, and any drugs you've been taking that might affect fertility. The woman will also be asked about her menstrual cycle, how regular it is, how long her periods last, and whether they're painful. You'll both also be asked about your jobs in case either of you could be exposed to dangers at work that may affect fertility. The doctor will also ask about any past sexually transmitted diseases, including chlamydia, and will look at past smear test results.
Primary tests for the woman:
- Smear test (if not done recently).
- Test for chlamydia, which will be treated if found.
- Physical examination, including an internal examination.
- A simple blood test for progesterone levels in the second half of the cycle to confirm whether ovulation is taking place.
Primary tests for the man:
- Physical examination of the man's penis and testes.
- A semen sample, which will be sent for analysis at the fertility clinic where further investigations and secondary tests will be done.
Rapid referral for secondary tests
In some circumstances couples are referred as quickly as possible for secondary investigations at a specialist unit. These include:
- If either partner is over 35 years of age.
- If the woman has a history of amenorrhoea (absence of periods), or oligomenorrhoea (sparse or infrequent periods).
- Abnormal anatomy on internal examination of the woman or a varicocoele of the scrotum in the man.
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