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 & 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.
If you're having trouble falling pregnant, you may want to seek advice from a fertility specialist to find out why it's taking longer than expected. A fertility work up will look into both the female and male factors that contribute to a successful pregnancy. Dr Fleur Cattrall, fertility specialist at Melbourne IVF, shares what you can expect at a fertility check up.
What does a fertility work up involve?
What does a fertility work up involve? - Fertile Minds Video
My name is Dr. Fleur Cattrall, and I am a Melbourne IVF Fertility Specialist. If you're having trouble falling pregnant, you'll want to go and see a fertility specialist, so we can organise some tests to work out why you're not falling pregnant.
If we start with the female, then we will look at ovulation, so are you producing an egg? To do this, the fertility specialist will ask you about your cycle length. That is the time from your Day One, your first day of period, until your next Day One. The textbooks would say that's 28 days, but it could be 24 days, it could be 35 days, it could vary every month. Leading up to your appointment with your fertility specialist, record this. This will be a good starting point for discussion about ovulation. Some women have already tracked through their cycle, and they've done some urine ovulation tests, or they've done some basal body temperature testing. They can show this to their fertility specialist, and this can be a bit of a guide for the fertility specialist on what needs to be done next.
To confirm ovulation, we often will do a blood test about a week after the egg's been released. Or in a 28 day cycle, when we think ovulation happened Day 14, we'll do a blood test Day 21. After ovulation, the ovulation site becomes a progesterone-producing factory, and the progesterone gets the lining of the uterus ready for pregnancy. Doing the blood test a week after ovulation can confirm that the progesterone is rising, ready for implantation.
The other thing that the fertility specialists will look at is your heaviness or your pain of your periods. Now, this is hard to know if it's normal, but first day of period, a little bit of period pain relieved with simple pain relief is probably normal. But if it's quite severe, you need time in bed, you have very, very heavy periods, then this is the clues that the fertility specialists will be looking for.
The next step, after taking a history, will be to organise a pelvic ultrasound, and this will look at a female's anatomy. Do they have a normal uterus? Do they have normal ovaries? On the ultrasound, we'll be looking for things like is the lining of uterus normal? Are there any polyps, which is an overgrowth of the lining of the uterus? Is there overgrowth of the wall of the uterus called a fibroid?
We'll also be looking at the ovaries. The ovaries sometimes contain ovarian cysts, which can prevent couples fall pregnant. The other thing we look at is the ovarian reserve. Now, we do that with both the ultrasound, looking at the ovaries, and we look at what's called the antral follicle count. This is a baseline egg number, and we'll be counting these in each ovary. And we also look at the ovarian reserve in the form of a blood test called the anti-mullerian hormone. Anti-mullerian hormone is released from the total pool of eggs in the ovaries and gives us a bit of a guide of your ovarian reserve. The ultrasound and the anti-mullerian hormone, together, will tell us whether your egg numbers are normal for your age, low or high. They don't, however, tell us about egg quality. We'll be looking at your female age to give us a guide on egg quality.
Now, the other thing that we think about with women is is there a pathway for the sperm and the eggs to meet? We do this by looking at your anatomy on the ultrasound, and we're looking at the fallopian tubes. But the fallopian tubes are really hard to see on a basic ultrasound, so we need to take the next step, and your fertility specialist may recommend to you a further test to put some fluid through the fallopian tubes to confirm that they're open and not blocked. This can be done in the ultrasound department where a speculum is put in, a bit like having a pap smear, and then a little catheter is put through the cervix, and fluid is put through to confirm that pathway is open.
For men, we look at the semen analysis. This is a classic test to confirm men are fertile. On this test, we're looking at the count, the quality, the movement, and the shape, and we also look for anti-sperm antibodies.
So there you go there. There are the initial steps that a fertility specialist will take to do a fertility workup. When you come back to see your fertility specialist, they will have all the results for you, and then we'll go through them and work out if there's any other tests that we need to do.
Thanks for watching. I hope this video was helpful for you. Good luck on your fertility journey, and if you have any comments, leave them below. If you want to see more videos, like this, click the subscribe button (for Fertile Minds). Take care and have a good day.
*All opinions expressed on the Fertile Minds YouTube Channel belong to the individual doctors, scientists and specialists, not the Virtus Health group.