Tests and treatments are available for both male and female fertility problems. Both partners will need to be tested and it's usually best if you attend appointments together - but follow the advice of your specialist.
Initial tests of your fertility can be started by your GP, who can give support and lifestyle advice.
It's best to have treatment for fertility problems under the care of a specialist team. This team will include a doctor - usually a specialist in women's health (obstetrics and gynaecology), and a counsellor. Seeing a counsellor can help you to cope with the stresses and strains that come with fertility problems and having fertility treatment.
If you have a regular cycle, you will have a test for your levels of the hormone progesterone seven days before your period is due. This checks that you are producing eggs (ovulating). Your blood will also be tested for the other hormones involved in getting pregnant.
You will have an ultrasound scan of your womb, fallopian tubes and ovaries. The best quality pictures are seen when the scanning probe is placed in the vagina (a transvaginal ultrasound). Your specialist may also suggest you have a laparoscopy, which is a keyhole operation to look directly at your ovaries and fallopian tubes. An alternative to a laparoscopy to check your fallopian tubes is a test called a hysterosalpingogram (HSG). This is a test where your doctor will inject a dye through your cervix while you have an X-ray. If your fallopian tubes are open, the dye can be seen to flow through them. HSG is an outpatient test, which means that you won't need to stay overnight in hospital.
For Men
You will need to take a sample of your semen to the clinic for testing. This will look at the numbers of sperm, how they move and whether they have a normal structure.
Treatment
The treatment that is best for you will depend on the cause of subfertility.
Helping you to ovulate
If all or part of the subfertility is to do with not ovulating (eg if you have polycystic ovary syndrome), treatments can stimulate your inactive ovaries to produce eggs. This is called ovulation induction. At its simplest, this involves taking a medicine called clomiphene (eg Clomid) or tamoxifen for six days each month. Your doctor may also prescribe a medicine called metformin if you have polycystic ovary syndrome and clomiphene wasn't effective on its own.
Controlling ovulation and collecting eggs
A more complex form of ovulation induction is used if you are preparing for the fertility treatments called in-vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). The aim is to control the timing of your monthly cycle accurately so that your eggs can be removed and fertilised on a specific day. A normal monthly cycle will produce only one egg, but with this method, which uses three hormones given at different times, you produce several ripe eggs at once. This is called superovulation and it increases your chances of a pregnancy.
Usually, the eggs are collected while you have an ultrasound scan. A thin needle is passed through your vagina and into your ovary. This is done as an outpatient procedure, so you won't need to stay overnight in hospital and you usually won't need a general anaesthetic.
Assisted conception
There are many different technologies that can help you to conceive. All of these aim to bring the sperm and an egg, or eggs, close together. The three main methods are as follows.
Intra-uterine insemination (IUI for short)
Sperm that have been washed and specially prepared are put inside your womb just before ovulation is due. This is usually the first method offered to couples who have unexplained infertility. It's also useful if there are ejaculation problems or mild problems with the quality of the sperm. IUI can be combined with ovulation induction (see Helping you to ovulate).
In vitro fertilisation (IVF)
IVF can be carried out with donor sperm or donor eggs. The sperm and embryos can also be frozen for future use, although there are strict legal rules, supervised by the HFEA, to regulate these procedures. You will need to discuss these methods with your specialist.
In the UK, the Human Fertilisation and Embryology Authority (HFEA) licenses clinics offering advanced fertility treatments such as IVF.
Eggs and sperm are mixed in a test tube in a laboratory - this is where the phrase
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