Considering the possibility of male or female infertility or the need for fertility treatment can be a hugely emotive and stressful prospect.

Investigating infertility problems might involve considering factors relating to males and/or females; both partners need to be investigated to discover the cause.

Certain lifestyle factors can affect fertility; they can be addressed fairly easily, to improve your chances of conceiving.

It’s important to note that, although some causes of infertility can be addressed and treated once diagnosed, not every cause of infertility can be corrected.

Infertility definition

According to the World Health Organization, infertility is defined as ‘the inability to achieve pregnancy after 12 or more months of regular unprotected sexual intercourse’.

Two types of infertility are:

Primary infertility – the inability to have a pregnancy
Secondary infertility – the inability to have a pregnancy after a previous successful conception.

It’s estimated that around 15% of reproductive-age couples worldwide are affected by infertility.

When to talk to your doctor about infertility

It’s generally considered that most couples (if the female partner is under 40) will conceive naturally within a year, if they are having regular, unprotected sex without contraception.

Of those couples who do not conceive within a year, around 50% will conceive naturally in the second year.

‘Regular sex’ is considered to be sex that happens every 2-3 days, without the use of condoms or other contraceptive methods.

If you and your partner have been unable to achieve pregnancy after a year of unprotected intercourse, it might be time to make an appointment with your doctor. It’s better if both you and your partner can attend together, as fertility problems can involve factors related to both males and females.

Infertility risk factors

You might also wish to contact your doctor if any of the following apply:

You have not conceived after a year of regular unprotected sex
You’re aged 36 years or more; fertility in women declines rapidly around the mid thirties, so it’s best to take action sooner rather than later. However, a poor ovarian reserve doesn’t mean you are infertile
You have a known condition that might cause fertility impairment – e.g. untreated sexually transmitted infections (STIs) – or you’ve received treatment for cancer.

What are the preliminary tests, when investigating infertility?

As part of the assessment for assisted reproductive technologies (ART), you’re required to undergo a number of routine investigations and fertility tests.

Investigations will involve a combination of different tests: a physical exam; fertility blood tests; and a pelvic ultrasound. Once the results of these are studied, more specific infertility tests might be necessary.

What to expect

Fertility doctors will make an initial assessment of your general health and medical history and will advise you of any infertility tests or investigations needed, prior to commencing any fertility treatment.

Health history

Your fertility specialist will take a full medical history and discuss with you any previous or current health conditions that might be affecting your fertility.

You can expect to be asked questions about any of the following:

Previous pregnancies – including previous miscarriages, pregnancy losses or terminations
Length of time you’ve been trying to conceive, and your sex life
Contraceptive methods; with some hormonal methods, it will take time, after stopping them, for your body to return to a regular menstrual cycle
Medical health history, including your menstrual cycle; irregular menstrual cycles or disruptions to the reproductive system can make ovulation and conception more difficult
Medications
Lifestyle risk factors: smoking; alcohol; illicit drugs; psychological stress and body mass index (BMI). All of these can affect fertility.

Physical examination

For women, a physical exam will check for any lumps or tenderness that could indicate infections, fibroids or tumors.

Certain symptoms might also point to other women’s health conditions, such as pelvic inflammatory disease, mild endometriosis or polycystic ovary syndrome.

For men, a physical examination of the testes and penis will be performed, to assess for any lumps or abnormalities.

Chlamydia testing might also be offered. Some STIs, such as chlamydia, can affect fertility; therefore, screening is common. This can be performed either from a swab, blood or urine test.

Preliminary blood tests

Fertility testing will always involve fertility blood tests. Men and women will undergo different blood tests, including the following:

Rubella
HIV
Blood group
Hormone levels
Hepatitis B & C
Sperm antibodies
CA-125.

For further information on blood tests, read BellyBelly’s article Blood Test For Pregnancy | What you need To Know.

Infertility blood tests: hormone levels

Reproductive hormones in both male and female partners are generally tested to assess levels.

For women, a blood test for infertility will measure hormonal levels. The hormones that will be checked will not only be ovarian hormones but also those secreated by the pituitary gland.

Fertility blood tests for hormones will most likely study the following: estrogens; luteinizing hormone (LH); human chorionic gonadotropin (hCG); thyroid stimulating hormone; anti müllerian hormone (AMH); prolactin; follicle stimulating hormone (FSH); and progesterone levels.

It’s best to measure hormone levels in the first week of a woman’s menstrual cycle, to check they are normal.

For men, testosterone and FSH levels will be tested, as both can affect sperm production.

The anti müllerian hormone is checked in both women and men as it’s a hormone produced by the ovaries and the testes respectively.

Research shows that the anti müllerian hormone plays a very important role in human reproduction. When investigating infertility, this is a very important blood test to be carried out on both partners.

Baseline ultrasound scan (women)

Among the fertility tests in reproductive medicine, a vaginal ultrasound can shed a lot of light when evaluating a woman’s infertility .

An ultrasound scan allows us to see the woman’s reproductive system in detail; it’s therefore possible to identify physical causes of infertility.

The scan is done:

To detect any physical changes to the reproductive organs – ovaries, fallopian tubes, uterus, cervix and vagina – that might affect a woman’s menstrual cycle
To check for cysts, polyps or fibroids or any other factors that could be the cause of infertility
To test the ovarian function and reserve, which is also important in evaluating infertility. This involves measuring the size of the ovaries and counting the number of small follicles present.

The ovarian reserve refers to the ‘reproductive potential’ left in a woman’s two ovaries, based on the number and quality of the eggs.

Ovarian reserve testing can diagnose diminished or reduced ovarian reserve, which can be a cause of female infertility.

If abnormalities are found, you might require a more in-depth assessment of the reproductive tract, using MRI imaging or diagnostic laparoscopy.

Further assessments for male infertility evaluation

Male infertility can be due to problems with sperm production, abnormal sperm function or blockages that prevent the delivery of sperm.

Although sperm collection and semen analysis might feel awkward or embarrassing at the time, it’s an important part of the process of fertility testing. Remember that the personnel who will be dealing with you and your sample are doing their normal day’s work and will find it quite commonplace.

Results from these tests can then guide future infertility treatments and management.

Semen analysis

Clinical examination of the sample will look at the volume and quality of a man’s sperm. The process involves collecting a sample and evaluating it under a microscope, in the lab.

Sperm analysis will evaluate things such as sperm count, activity (sperm motility) and shape.

Semen analysis might also include tests for sperm antibodies in the semen and checks for white cell count and pH, which could indicate possible infections that might affect male fertility.

Unexplained infertility

Despite undergoing multiple tests and infertility evaluation, some infertile patients will find no obvious cause or reason for their infertility. This is known as an unexplained infertility diagnosis.

Although it can be extremely frustrating and upsetting to find no reason for not being able to conceive when you so desperately want to have a baby, try not to lose hope. Many couples with unexplained infertility are still able to go on to conceive naturally, with or without assisted reproductive technology.

There have been many advances in assisted reproductive technologies over the years and more couples than ever before are able to achieve their dreams of becoming parents.

Infertility and emotional well-being

Going through the process of infertility testing or infertility treatment can be an incredibly emotional and stressful time for couples and can put strain on your relationship. It’s not always straightforward and can be a lengthy process.

Stresses and strains will affect each partner differently, so it’s important that you’re there to support each other during this time.

Try to:

Talk to each other. Although it seems an obvious thing to say, sometimes, when we’re stressed, we hold back on things for fear of upsetting the other. Remember you’re both going through this journey together, and talking will naturally reduce stress
Be patient with each other. There might be a whole range of emotions that each of you will go through but you might experience them at different stages. This is ok and perfectly normal. Be patient, kind and mindful of each other’s feelings
Be supportive of each other’s needs. Your needs might differ, but try to be supportive of what the other one needs to get through this potentially stressful time.

Most couples that follow our fertility program have no physical impediment to achieving pregnancy. I’d go further: most couples who end up having IVF or other fertility treatment have no physical obstacle to achieving a healthy pregnancy.

Check out our natural fertility program: Natural Fertility