When to see your GP
About 85% of couples conceive naturally after one year of having regular (every 2-3 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, or
- you are a woman who is over 35 years of age.
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 be caused by a male or female or, in some cases, both.
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 many 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 your fertility problems. Your GP may discuss the areas that are covered below with you.
Age
As fertility in women declines as they get older, your GP will want to know how old you are.
Children
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 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. About 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
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 about this. If the fertility problem is to do with sex, it can sometimes be easily overcome.
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 you have had in the past, such as sexually transmitted infections (STIs). If you are a woman, your GP may ask about your periods - for example, whether they are regular, and if you experience any bleeding between periods or after sex.
Medication
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.
Lifestyle
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, and
- 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 further tests.
Physical examination for women
When carrying out a physical examination your GP may:
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. These are described below.
Progesterone test
During a progesterone test, a sample of your blood can be tested for progesterone to check whether you are ovulating. The test should be taken seven days before you expect your period.
Hormone tests
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 test
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 chlaymida, you will be prescribed antibiotics to treat it.
Thyroid function test
It is estimated that between 1.3-5.1% 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.
Hysterosalpingography
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.
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). High frequency sound waves will be used to create an image of your womb and fallopian tubes in order to highlight any abnormalities.
Laparoscopy
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 only likely to be used if there is a strong likelihood 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, and
- check your penis - to look at its shape and structure, and to look 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, and
- a chlamydia test - a sample of your urine will be tested to determine whether you have chlamydia. If you do, your GP will prescribe antibiotics to treat it.
