There are various causes of infertility which may be related to female, male or a combination of male and female factors. Female causes are usually related to the woman's age, issues with ovulation or pelvic anatomy, such as endometriosis or polycystic ovarian syndrome (PCOS).
Following your initial consultation with your fertility specialist, you can expect that several investigations will be arranged. These may include blood tests and a pelvic ultrasound for the female and semen analysis for the male.
The first test in fertility assessment is to establish whether or not you are releasing an egg every month (ovulating). Your fertility specialist will advise on the most appropriate investigation for you.
This may include:
- a urinary ovulation detection kit,
- a mid-luteal (one week after ovulation) blood test to measure progesterone level, and
- an ultrasound scanning to assess follicle growth.
Ultrasound scanning can also be used to assess the lining (endometrium) of the uterus and to diagnose the presence of any polyps or fibroids.
Your fertility specialist may also recommend a blood test for AMH to provide an estimate of your ovarian reserve.
Checking the fallopian tubes and uterus
Your fertility specialist may recommend an ultrasound scan of the pelvis to assess the uterus and ovaries. This may be combined with a test for tubal patency (whether there is any obstruction or blockage of the fallopian tubes).
Diagnostic laparoscopy and hysteroscopy
These important tests require a general anaesthetic and are performed in an operating theatre. You may not need these investigations if the need for in vitro fertilisation (IVF) is already apparent – your fertility specialist will advise you.
During a laparoscopy, a small-diameter telescope (laparoscope) is passed through an incision in the umbilicus to view the uterus, fallopian tubes, ovaries and pelvic cavity. Tubal patency can also be checked by injecting dye through the uterus.
Hysteroscopy uses a similar small telescope (a hysteroscope) to assess the uterine cavity for polyps, fibroids, adhesions or congenital anomalies.