Subfertility is a common problem affecting one in seven couples in the UK. The purpose of the Subfertility Clinic is to assess the problem, investigate possible causes, and provide appropriate treatment where possible. The clinic is staffed by Consultant Gynaecologists and Nurse Specialists.
Subfertility can cause considerable anxiety and distress. The clinic aims to provide helpful advice, support, and information. This page prepares you for your first visit by explaining the initial assessment and possible tests.
Preparing for Your First Appointment
- Attend as a couple if possible, as assessment involves both partners. If not possible, the female partner may attend alone, but results for the male partner cannot be discussed unless present.
- Make a note of the date your last period started. If your period starts on or close to your appointment, still attend as menstruation need not delay assessment.
- Bring the completed questionnaire sent with your appointment card.
- General health aspects will be discussed, including lifestyle, weight, diet, alcohol intake, and smoking habits.
- If your BMI is 30 – 35, some investigations and treatment may be postponed until you have lost weight.
- Both partners are strongly advised to be non-smokers or working towards stopping smoking. For NHS funded fertility treatment, both partners must be non-smokers and nicotine free.
Initial Tests
- Some tests may already have been arranged by your GP, such as blood tests (female partner) or semen analysis (male partner). These do not need to be repeated unless results are unsatisfactory.
- The female partner will have a vaginal ultrasound scan to examine the uterus and ovaries. This is similar to an internal examination and should not be uncomfortable. The bladder must be emptied before the scan. Vaginal ultrasound can be carried out even if menstruating, unless you prefer not to be examined at that time.
- Further tests may be arranged for one or both partners after the initial assessment.
Female Investigations
- Blood hormone levels: Some female hormones are measured at specific times in the cycle to check for ovulation. Tests may be repeated if cycles are irregular or periods absent.
- Rubella (German measles): If non-immune, there is a small risk of fetal abnormalities if exposed during early pregnancy. A blood sample may be taken to check immunity, and vaccination arranged if needed.
- Chlamydia: A common sexually transmitted infection that can cause pelvic pain and infertility if untreated. If not already tested, a swab will be taken at the clinic.
- Tubal patency testing: Healthy fallopian tubes are essential for pregnancy. Two methods may be used:
- Hysterosalpingogram: A special x-ray of the fallopian tubes using a radio-opaque solution injected through the womb. X-rays are taken as the solution travels through the tubes. The test takes 10 – 15 minutes and does not require a hospital stay.
- Laparoscopy and hydrotubation: Performed under general anaesthetic, usually requiring a morning or afternoon hospital stay. A small incision is made below the umbilicus, and a slim telescope is used to examine the uterus, tubes, and ovaries. Blue dye is injected to check tubal patency. Up to a week off work may be needed afterwards.
Male Investigations
- Semen analysis: The male partner produces a semen sample by masturbation into a sterile container. The sample can be produced at home and brought to the laboratory within 30 – 45 minutes. If you live far from the hospital, a room can be provided at the clinic. Do not bring a sample to the initial appointment; an appointment will be arranged if needed. If the first test is unsatisfactory, a second test will be arranged 4 weeks or 3 months later, depending on results.
- Blood tests: Occasionally required if sperm count is very low on two occasions.
Results of Investigations
- The tests may help diagnose the cause of subfertility. Waiting for results can be stressful, but every effort will be made to keep you informed as soon as possible.
- Investigations can take a few weeks to complete, as many must be coordinated with the female menstrual cycle and may need to be repeated.
- Results are normally provided by letter or telephone consultation with the Fertility Nurse Specialist.
- If a specific cause is found (e.g., problems with ovulation, sperm, or tubal function), further appointments will be arranged to discuss treatment options.
- In many cases, the cause may be “unexplained”. Continuing to try to conceive naturally for a reasonable length of time is often more successful than introducing treatment, but advice will be given as appropriate.
