In Australia one in six couples deal with infertility. You need to seek medical assistance if you have been having unprotected intercourse for one year. This means you have met the clinical definition of infertility. However, if you are over 35 you should see your doctor after six months of trying to conceive as your window for successful conceiving is reducing. If you have a past history of infertility or gynaecological problems such as endometriosis, fibroids, pelvic inflammatory disease, irregular or absent periods or painful periods you should seek help earlier.
When you see your doctor he will ask you about your medical history, in particular details about your menstrual cycle, reproductive history, any underlying medical conditions and any previous illnesses or surgery that may be affecting your fertility. As well as obtaining information regarding your personal history some medical tests will be ordered to try and determine what the potential problem may be. Blood tests will include investigations to see if you are ovulating and a thyroid function test. A pelvic ultrasound and tubal patency ultrasound will show structural abnormalities or endometriosis, in which instance you may require surgical treatment. A semen analysis on your partner is also necessary to ensure his sperm are healthy and motile. If male infertility turns out to be a factor your partner may be referred to an andrologist (semen analysis specialist). If blood tests show that you are not ovulating medication such as Clomiphene Citrate may be recommended. The dose can be altered according to future blood test results.
There are many possible factors for infertility that include lack of ovulation, premature ovarian insufficiency (early menopause) anatomical problems such as non-patent fallopian tubes or a problem within the uterine cavity. In many instances there is no obvious reason for a couple – this is called unexplained infertility.
Once all of your tests results are back, depending on the problem, treatment will be organised and options discussed. If tests suggest you are not ovulating this is often amenable to treatment with medication to induce ovulation. Progesterone levels are checked via blood tests and are performed at a particular time during the cycle to assess if you are ovulating. Sometimes a surgical procedure such as a laparoscopy, hysteroscopy and D&C may be necessary in order to assess the pelvis and uterus. A management plan will be indicated depending on all of the information following consultation and test results. If assisted fertility such as IVF is required appropriate referral can be made.