Understanding Infertility: Diagnosis and Next Steps

Struggling to conceive can be an emotional and challenging experience, leaving many couples wondering why it’s taking so long and what steps to take next.

Infertility affects approximately 1 in 7 couples, making it a common issue. Yet, despite its prevalence, the experience can feel isolating—especially when it seems like everyone around you is starting or growing their families. Couples and individuals from the LGBTQ+ community or those seeking solo motherhood face unique challenges on top of any physical aspects.

Taking proactive steps to identify potential causes is the first move toward overcoming fertility challenges. While it’s recommended to consult a doctor as soon as infertility concerns arise, general guidelines suggest seeking medical advice after trying for 12 months if you're under 35, or after 6 months if you’re 36 or older.

Infertility can arise from a variety of underlying factors. Here are some of the most common causes for both men and women:

• Polycystic Ovary Syndrome (PCOS): Affects 1 in 10 women.

• Endometriosis: Another condition impacting 1 in 10 women.

• Blocked Fallopian Tubes: Often the result of infections like Pelvic Inflammatory Disease or scarring.

• Thyroid Issues: Includes both underactive and overactive thyroid conditions.

• Hypothalamic Amenorrhoea: Disruption in menstrual cycles due to low hormone levels.

• Male Factor Infertility: Poor sperm count, shape, or motility.

• Uterine Abnormalities: Such as fibroids.

• Premature Ovarian Insufficiency: Early decline in ovarian function.

• Medications and Drug Use: Chemotherapy and certain recreational drugs can impair fertility.

• Irregular or Infrequent Intercourse

In some cases (about 25%), no specific cause can be identified, which is referred to as unexplained infertility.

If you’re worried about your fertility, it’s essential to consult a healthcare provider. While infertility doesn’t always present clear symptoms, here are some potential warning signs to look out for:

• Irregular or absent periods.

• Heavy or painful menstrual cycles.

• Inability to conceive after 12 months of trying (or 6 months if over 35).

• History of pelvic inflammatory disease.

• Elevated or low BMI (healthy BMI is between 18 and 25).

• Smoking or recreational drug use.

• Advanced age (conception becomes harder after age 35).

• Recurrent miscarriages.

• Symptoms like hot flushes or night sweats.

Even if no symptoms are present, seeking medical advice can still be beneficial.

Understanding your fertility status can involve a variety of tests for both partners. Here’s a breakdown:

Tests for Women

The initial step involves bloodwork to assess reproductive health. These tests can be done through your doctor or at-home services offered by private providers. 

Key blood tests include:

• Hormone Profile: To check levels of estradiol, FSH, LH, and progesterone.

• Thyroid Function: to include TSH

• Prolactin: A hormone that may affect ovulation if levels are abnormal.

• Vitamin D: Essential for overall reproductive health.

You may also want to undergo a sexual health screening, available through your GP, a clinic, or online providers.

If conception hasn’t occurred after 6 months (for women 36 and older) or 12 months (for women under 35), further investigations may be necessary, including:

• Ultrasound Scans: To assess the uterus and ovaries, as well as follicle counts (Antral Follicle Count).

• Ovarian Reserve Tests: Measuring Anti-Mullerian Hormone (AMH) levels, though this may only be available privately.

• Specialised Procedures: Such as HyCoSy (Hysterosalpingo-Contrast Sonography) to examine the fallopian tubes.

Referral to a fertility specialist is usually recommended at this stage.

Tests for Men

Male partners should start with a semen analysis to assess sperm count, shape, and motility.

If abnormalities are detected, the test is typically repeated after three months. If issues persist, further investigation with a urologist may be required.

Men can also undergo a sexual health screening and may choose to explore advanced testing, such as sperm DNA fragmentation, though this is typically only available privately.

When you consult a doctor about infertility concerns, they’ll likely ask several questions to help pinpoint potential issues. 

Here’s what to expect:

• How long have you been trying to conceive?

• When did you stop using hormonal contraception?

• Do you have any medical or gynaecological history (e.g., PCOS, endometriosis)?

• Have you had any previous pregnancies, miscarriages, or terminations?

• Are you taking any prescribed medications or supplements?

• How often do you have intercourse? (It’s recommended to have sex every 2-3 days throughout the cycle.)

• Have you or your partner had any sexually transmitted infections (STIs)?

• What is the length and regularity of your menstrual cycle?

• Do you experience heavy or painful periods or pain during sex?

• Do you smoke, vape, or drink alcohol? What’s your diet and exercise routine like?

The answers to these questions will guide your doctor in determining the next steps, whether further testing or lifestyle adjustments.

Experiencing infertility can feel overwhelming, but understanding the diagnostic process is the first step toward finding solutions. 

Remember, every fertility journey is unique, and what works for one couple may not work for another. Consulting with your doctor early and being proactive about your health can make all the difference in achieving your family goals.