Diagnosis of infertility (2024)

More than 8 in 10 couples, where the woman is under 40, will conceive naturally within a year of having regular unprotected sex.

Regular unprotected sex means having sex every 2 to 3 days without using contraception.

When to get medical help

See your GP if you have not conceived after a year of trying.

You should see a GP sooner if:

• you are female and are aged 36 or over – the decline in fertility speeds up when reaching your mid-30s
• have any other reason to be concerned about your fertility, for example, if you've had treatment forcanceror you think you might have had a sexually transmitted infection (STI)

Fertility tests can take time and female fertility decreases with age, so it's best to make an appointment early.

The GP will be able to do an initial assessment to check for things that may be causing your fertility problems and advise you about what to do next.

It's always best for both partners to visit the GP as fertility problems can affect either or both partners.

Trying to conceive can be an emotional process,so it's important to support each other as much as possible.Stress is just one factor that can affect fertility.

Questions your doctor may ask

The GP will ask youabout your medical and sexual history.

Previous pregnancies and children

If you're a woman, the GP will discuss any previous births and any complications with previous pregnancies.

They'll also ask about anymiscarriages you've had.

If you're a man,you'll beasked whether you've had any children from previous relationships.

Length of time trying to conceive

The GP will ask how long you've been trying to conceive.

More than 8 out of 10 couples, where the woman is under 40, will conceive within 1 year if they have regular unprotected sex (every 2 to 3 days).

Of those who do not conceive in the first year, about half will conceive in the second year.

If you're under 40 and have not been trying for a baby for very long, you may be advised to keep trying for a little longer.

Sex

You'll be askedhow often you have sex and whether you have any difficulties during sex.

You may feel uncomfortable or embarrassed discussing your sex life with the GP, but it's best to be open and honest.

If the fertility problem is related to sex, it might be overcome easily.

Length of time since stopping contraception

You'll be asked aboutthe type ofcontraception you previously used and when you stopped using it.

It can sometimes take a while for some types of contraception to stop working and this may be affecting your fertility.

Medical history and symptoms

The GP will discuss any medical conditions you have or had in the past, includingsexually transmitted infections (STIs).

If you're a woman, the GP may ask if you have regularperiods and whether you experience any bleeding between periods or after sex.

Medicine

Some medicines can affect your fertility. The GP will ask you about any medicine you're taking and might discuss alternative treatments with you.

You should mention any non-prescription medicine you're taking, including herbal remedies and supplements.

Lifestyle

Several lifestyle factors can affect your fertility. The 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're stressed

They may recommend making changes to your lifestyle to increase your chances of conceiving.

Read more about:

• Trying to get pregnant

After asking you questions, the GP maydoa physical examination or refer you for tests.

Physical examination

If you are female, the GP may:

• weigh you to see if you have a healthybody mass index (BMI)
• examine your pelvic area to check for infection, lumpsor tenderness, which could be a sign offibroids, ovarian tumours, endometriosisorpelvic inflammatory disease (PID)– see causes of infertility

If you are male, the GP may check your:

• testicles to look for any lumps or deformities
• penis to look at its shape, structure and any obvious abnormalities

After a physical examination,youmay bereferred to a specialist infertility team at an NHS hospital or fertility clinic forfurther tests.

Fertility tests for women

Tests to find out the cause of infertility in women include:

Blood tests

Samples of your blood can be tested for a hormone called progesterone to check whether you're ovulating.

The timing of the test is based on how regular yourperiods are.

If you have irregular periods, you'll be offered a test to measure hormones called gonadotrophins, which stimulate the ovaries to produce eggs.

Chlamydia test

Chlamydiais an 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.

A urine test may be used as an alternative.

You'll be prescribedantibioticsif you have chlamydia.

Ultrasound scan

An ultrasound scan can be used to check your ovaries, womb (uterus) and fallopian tubes. Certain conditions that can affect the womb, such as endometriosis and fibroids, can prevent pregnancy.

Ascan can also be used to look for signs that your fallopian tubes(the tubes that connect the ovaries and the womb)may be blocked, which may be stopping eggs from travelling along the tubes and into the womb.

If the ultrasound suggests a possible blockage, your doctor will refer you to a specialist to discuss further checks, such as alaparoscopy.

During a transvaginal ultrasound scan, an ultrasound probe is placed in your vagina. The scan can be used to check the health of your womb and ovaries and for any blockages in your fallopian tubes.

A hysterosalpingo-contrast-ultrasonography is a special type of ultrasound scan sometimes used to check the fallopian tubes.

A small amount of fluid is injected into your womb through a tube put into the neck of your womb (the cervix).

Ultrasound is used to look at the fluid as it passes through the fallopian tubes to check for any blockages or abnormalities.

If the test suggests a possible blockage, your doctor will refer you to a specialist to discuss further checks, such as laparoscopy.

X-ray

A hysterosalpingogram is an X-rayof your womb and fallopian tubes after a special dye has been injected.

It can be used to find blockages in yourfallopian tubes,which may be stopping eggs travelling along the tubes and into your womb.

Laparoscopy

Laparoscopy (keyhole surgery) involves making a small cut in your lower tummy so a thin tube with a camera at the end (a laparoscope) can be insertedto examineyour womb, fallopian tubes and ovaries.

Dye may be injected into your fallopian tubes through your cervix to highlight any blockages in them.

Laparoscopy is usually only used if it's likely that you have a problem – for example, if you've had an episode ofpelvic inflammatory disease (PID) in the past, or if scans suggest a possible blockage of one or both of your tubes.

Fertility tests for men

Tests to find out the cause of infertility in men include:

Semen analysis

This is tocheck for problems with sperm, such as a low sperm count or sperm that are not moving properly.

Chlamydia test

Asample of your urine will be tested to check forchlamydia, as it can affect fertility.

Your GP will prescribeantibiotics if you have chlamydia.

Read about the different treatments for infertility.