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 advise about what to do next, and carry out an initial assessment to investigate things 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 an emotional one, so it is important to support one another as much as possible. Stress is just one of the things that can affect fertility.
Medical, sexual and social history
When you visit your GP, they will want to discuss your full medical, sexual and social history. This will help them identify what may be causing fertility problems.
Age
Your GP will discuss your age, as fertility in women declines with age
Children
If you are a woman, your GP will want to discuss with you any previous births and related complications with your pregnancy (if there were any). They will also ask about any miscarriages you may have had.
If you are a man, you will be asked whether 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.
Sex
You will be asked 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
You will be asked about the type of contraception you previously used, 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 want to discuss any medical conditions you have, or have had in the past, including sexually transmitted infections (STIs). If you are a woman, your GP may ask how regular your periods are and whether you experience any bleeding between periods or after sex.
Medication
The side effects of some medication can affect your fertility. So your GP will look at any medication you are taking, and might discuss alternative treatments with you. You should mention any non-prescription medication you are taking, including herbal medicines.
Lifestyle
Several lifestyle factors can affect your fertility. Your GP will want to know:
- if you smoke
- how much you weigh
- how much alcohol you drink
- whether you take any illegal drugs
- if you are stressed
They may recommend changes to your lifestyle to increase your chances of conceiving. Read more about preventing infertility.
After taking a medical, sexual and social history, your GP may carry out a physical examination or refer you for tests.
During a physical examination your GP may:
After your medical history and physical examination have been considered, you may be referred to a specialist infertility team at an NHS hospital or fertility clinic for further tests and procedures. These are outlined below.
Tests for women
For women a number of tests can be used to try to establish the cause of infertility.
Progesterone test
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.
Hormone tests
If your periods are irregular, the level of follicle-stimulating hormone (FSH) and luteinising hormone in your blood may be tested along with thyroid hormone, prolactin and testosterone.
Chlamydia test
Chlamydia is a sexually transmitted infection (STI) that can affect fertility. A swab (similar to a cotton bud, but smaller, soft and rounded) is used 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.
Hysterosalpingogram
A hysterosalpingogram is a type of X-ray taken of your womb (uterus) and fallopian tubes after a special dye has been injected. This will outline the cavity of your womb and detect any blockage of the fallopian tubes.
Hysterosalpingo-contrast-ultrasonography
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). Ultrasound is used to confirm whether this fluid spills through the tubes.
Laparoscopy
A laparoscopy involves making a small incision (cut) in your lower abdomen. A thin, tubular telescope 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.
