When to see your GP
Around 85% of couples conceive naturally within one year of having regular (every two to three days) unprotected sexual intercourse. You should visit your GP if you have not conceived after one year of trying.
You should visit your GP sooner if:
- you have any reason to be concerned about your fertility, for example, if you have had treatment for cancer
- you are a woman over the age of 35
Fertility testing and investigation can be a lengthy process, and female fertility decreases with age, so it is best to make an appointment early on.
Your GP will be able to give you advice about what to do next, and they will also carry out an initial assessment to investigate factors that may be causing your fertility problems.
It is always best for both partners to visit their GP because fertility problems can affect a man or a woman, or sometimes both partners.
The process of trying to conceive can be a very emotional one, so it is important that you try to support one another as much as possible. Stress is just one of the factors that can affect fertility.
Medical, sexual and social history
When you visit your GP, they will want to find out about your full medical, sexual and social history. This will help them to identify any possible factors that may be causing fertility problems. Your GP may discuss some of the areas below with you.
As fertility in women declines as they get older, your GP will want to know how old you are.
If you are a woman, your GP will ask you if you have given birth previously and, if so, whether there were any complications with your pregnancy. They will also ask about any miscarriages that you may have had.
If you are a man, your GP will ask you whether or not you have had any children from previous relationships.
Length of time trying to conceive
Your GP will ask how long you have been trying to conceive. Around 95% of couples are able to conceive naturally after two years of having unprotected sex. If you are young and healthy, and you have not been trying for a baby for very long, you may be advised to keep trying for a little longer.
Your GP will ask how often you have sex, and whether you have any difficulties during sex. You may feel uncomfortable or embarrassed about discussing your sex life with your GP. However, it is very important to be honest and open. If the fertility problem is to do with sex, it might be overcome easily.
Length of time since stopping contraception
Your GP will ask you about the type of contraception that you were previously using, and when you stopped using it. It can sometimes take a while for certain types of contraception to stop working, and this may be affecting your fertility.
Medical history and symptoms
Your GP will ask you about any medical conditions that you have, or have had in the past, such as sexually transmitted infections (STIs). If you are a woman, your GP may ask about your periods, such as whether they are regular and if you experience any bleeding between periods or after sex.
The side effects of some medication can affect your fertility. Therefore, your GP will look at any medication that you are taking, and they might discuss alternative treatments with you. You should inform your GP about any non-prescription medication that you are taking, including any herbal medicines.
Several lifestyle factors can affect your fertility. Your GP will ask you:
- if you smoke
- how much you weigh
- how much alcohol you drink
- whether you take any illegal drugs
- if you are stressed
Your GP may discuss ways that you could improve your lifestyle in order to increase your chances of conceiving.
After taking a medical, sexual and social history, your GP may conduct a physical examination or refer you for tests.
Physical examination for women
When carrying out a physical examination your GP may:
- weigh you, to see you whether you have a healthy body mass index (BMI) for your height and build
- examine your pelvic area, to check for vaginal infection, or tenderness, which could be an indication of endometriosis or pelvic inflammatory disease (PID) (see Causes)
After your GP has considered your medical history and carried out a physical examination, they may refer you to a specialist infertility team at an NHS hospital or fertility clinic for some further tests and procedures. These are outlined below.
Tests for women
For women, there a number of tests that can be used to try to establish the cause of infertility.
During a progesterone test, a sample of your blood can be tested for progesterone to check whether you are ovulating. The test is taken seven days before you expect your period to start.
If your periods are irregular, the level of follicle-stimulating hormone (FSH) and luteinising hormone in your blood may be tested. If you have symptoms of an ovulation disorder, such as polycystic ovary syndrome (PCOS), your level of prolactin, another hormone, may also be tested.
Chlamydia is a sexually transmitted infection (STI) that can affect fertility. Your GP will use a swab (similar to a cotton bud, but smaller, soft and rounded) to collect some cells from your cervix to test for chlamydia. If you have chlamydia, you will be prescribed antibiotics to treat it.
Thyroid function test
It is estimated that between 1.3% and 5.1% of infertile women have an abnormal thyroid. If you have any symptoms of a thyroid abnormality, such as weight loss or weight gain, your thyroid gland will be tested to check whether it is functioning properly.
A hysterosalpingography is a type of X-ray that is taken of your womb (uterus) and fallopian tubes after a special dye has been injected. This will detect any abnormalities or defects, such as tumours (growths) or scar tissue.
A hysterosalpingo-contrast-ultrasonography is a type of ultrasound scan. A small amount of fluid will be injected into your womb through a tube that is put into your cervix (the womb opening). High frequency sound waves will be used to create an image of your womb and fallopian tubes to highlight abnormalities.
A laparoscopy involves making a small incision (cut) in your lower abdomen. A thin, tubular microscope called a laparoscope will be used to look more closely at your womb, fallopian tubes and ovaries. Dye may be injected into your fallopian tubes through your cervix in order to highlight any blockages in them.
A laparoscopy is usually only used if there is a strong chance that you have a problem, for example, if you have had an episode of PID in the past.
Examination and tests for men
During a physical examination, your GP may check:
- your testicles, to look for any lumps or deformities
- your penis, to look at its shape and structure, and for any obvious abnormalities
Further testing may include:
- a semen analysis. Your semen will be tested to determine whether you have a low sperm count, low sperm mobility, or abnormal sperm
- a chlamydia test. A sample of your urine will be tested to determine whether you have chlamydia
If you do have chlamydia, your GP will prescribe antibiotics to treat it.
Ovulation is when an egg is released from a woman's ovaries.
The ovaries are two small, round organs in the female reproductive system that release an egg every month.
The tubes connecting the ovaries to the womb.
The womb (or uterus) is a hollow, pear-shaped organ in a woman where a baby grows during pregnancy.
The testicles are part of the male reproductive system. They produce sperm and are located within the scrotum (a loose bag of skin) hanging down behind the penis.
Semen is the fluid released when a man ejaculates. It is made up of sperm produced in the testicles plus fluid from the prostate and seminal vesicle glands.
The neck of the womb in a woman.
The thyroid gland is found in the neck. It produces hormones that are released into the bloodstream to control the body's growth and metabolism.
An ultrasound scan, sometimes called a sonogram, is a procedure that uses high frequency sound waves to create an image of part of the inside of the body, such as the heart.
An X-ray is an imaging technique that uses high-energy radiation to show up abnormalities in bones and certain body tissue, such as breast tissue.