Subfertility is a common problem affecting one in seven couples in the UK. The purpose of the Subfertility Clinic is to assess and investigate the possible causes and provide the appropriate treatment, where possible.
The Clinic is staffed by Consultant Gynaecologists and Nurse Specialists. It is recognised that subfertility can cause considerable anxiety and distress and this page aims to provide helpful advice and support, as well as information. It also aims to prepare you for your first visit to the Clinic by explaining what the initial assessment involves and what tests may be carried out.
You are advised to attend as a couple at the first appointment since the assessment of subfertility involves both partners. However, if you are unable to attend as a couple (perhaps due to work or social commitments) it is acceptable for the female partner to attend alone. Please be aware that staff will be unable to discuss any test results for the male partner (if applicable).
It is helpful if you can make a note of the date your last period started. If your period starts on or close to your appointment, you should still attend as menstruating need not delay your assessment.
You will have been asked to fill in a questionnaire enclosed with your appointment letter and you should bring this with you. Staff will also discuss general aspects of your health including lifestyle, weight, diet, alcohol intake and smoking habits, as appropriate.
If your BMI is between 30 and 35 some investigations and treatment may have to be postponed until you have lost weight. It is strongly advised that both partners are non-smokers or working towards stopping smoking (for NHS funded fertility treatment, both partners must be non-smokers and nicotine free).
First Appointment
Some of the initial tests may already have been arranged by your GP Practice, such as blood tests (female partner) or seminal analysis (male partner) and these do not have to be repeated unless a result is reported as unsatisfactory. The female partner will have a vaginal ultrasound scan to examine her uterus and ovaries. This is similar to having an internal examination and should not be uncomfortable. The bladder should be emptied before having the scan done.
A vaginal ultrasound scan can still be carried out even if you are menstruating (unless you prefer not to be examined at this time). Once the initial discussion and assessment have been complete, staff may arrange further tests for one or both partners. Not all tests listed are necessarily appropriate for you, but the list simply serves as a guide to what we may recommend for you.
Female Investigations
Blood hormone levels – It is useful to measure some female hormones. Some of these tests are taken at a specific time in your menstrual cycle when expected levels indicate whether or not you have ovulated. It may be necessary to repeat some blood tests to confirm the diagnosis particularly if you have an irregular cycle or absent periods.
Rubella (German measles) – If you are non-immune to rubella, there is a small risk of fetal abnormalities if you are exposed to rubella in early pregnancy. Staff may take a blood sample to make sure that you are immune and, if not, they will arrange for you to be vaccinated to protect any future pregnancy.
Chlamydia – is one of the most common sexually transmitted infections. It is very easy to treat and cure but if left untreated can cause complications in females such as pelvic pain and infertility. If this test has not already been carried out, we will arrange a swab to be taken at your clinic appointment.
Tubal patency testing – healthy fallopian tubes are essential for pregnancy to occur. The tubes are delicate structures that can become blocked or damaged by adhesions or infection.
There are two methods of tubal patency testing and staff will advise which is the more appropriate for you:
- Hysterosalpingogram: this is the most common and least invasive procedure to check tubal patency. A special X-ray of the fallopian tubes which involves injecting a small amount of a radio-opaque (X-ray sensitive) solution through the neck of your womb with a fine catheter and taking X-rays as the solution travels through the fallopian tubes. The test takes only 10-15 minutes to complete and you do not need to stay in hospital or take time off work.
- Laparoscopy and hydrotubation – This is carried out under a general anaesthetic. Normally, you only have to stay in hospital for the morning or afternoon. A small incision is made just below the umbilicus (navel) and the abdomen is distended with gas which allows the consultant to insert a slim telescope into the pelvis and examine the uterus, fallopian tubes and ovaries. A small amount of blue dye is injected through the cervix at the same time to determine whether the fallopian tubes are patent. After the procedure the gas is released and a dissolving suture is used to close the incision. You will need to take up to a week off work afterwards.
Male Investigations
Semen analysis – this requires a man to produce a sample of semen by means of masturbation directly into a sterile container.
The sample can be produced at home and brought to the laboratory within 30 – 45 minutes. If you live some distance away from the hospital and cannot submit the sample within the recommended timescale, staff may be able to arrange for you to produce a sample in the Clinic (a room with facilities will be made available to you).
Please do not bring a sample with you at the initial appointment.
If you have not already provided a sample, staff will arrange an appointment for you. If the first test is reported as unsatisfactory, a second test will be arranged four weeks or three months later, depending on the results of the test.
Blood tests – very occasionally, staff may need to take a blood test from the male partner if the sperm count has been very low on two occasions. Staff will advise you if this is required.
Results of Investigations
The above tests may help diagnose the cause of your subfertility. Staff recognise that waiting for results is stressful and will make every effort to keep you informed as soon as possible.
Please be aware that certain investigations can take a few weeks to complete as many have to be co-ordinated with the menstrual cycle and, perhaps, repeated to make the diagnosis more certain.
You will normally be informed of the results by letter or via a telephone consultation with a Fertility Nurse Specialist.
If a specific cause is found for your subfertility (e.g. issues with ovulation, sperm or tubal function) staff will arrange to discuss this with you, and any treatment options, at a further appointment.
In many cases the cause of an inability to conceive will be unexplained, i.e. no obvious reason is found. In these cases, continuing to try and conceive naturally for a further reasonable length of time is usually more successful than introducing treatment, but staff will advise you of this, if appropriate.
