If you and your partner has tried to conceived for one year without succeeding, it can be a good idea to see a physician. By trying to conceive, we mean having unprotected sex every two to three days.
In some situations, it is advisable to not wait a year before seeking a medical evaluation. If there is any risk of any of you having a sexually transmitted infection, that is something that you should be tested for right away. You should also consider not waiting a whole year if you have any special reason to be concerned about infertility, such as any of you having been treated for cancer in the past, a history of fertility problems in either of your families or the woman being over 35 years of age.
It should be noted that 80% of heterosexual couples who have unprotected sex every two to three days will conceive naturally within a year if the woman is under 40 years of age. Of those who don’t conceive within the first year, about half will do so in the second year without fertility treatment. Fertility testing can take time, however, and since female fertility tends to decrease sharply after the age of 35 it is good to make an appointment without waiting a full year if the woman is 35+. Any future fertility treatments will have a greater chance of success if they get started sooner rather than later.
Meeting the physician
During your meeting with the physician, you can be expected to be asked many questions about your health and your medical history.
Examples of things that the physician most likely will ask:
- For how long have you been trying to conceive? How often have you had sexual intercourse during that time? Do you experience any difficulties during sex?
- What contraception method or methods have been used in the past, if any? How far back was that?
- How regular is the woman’s period? How long are the cycles? Does she experience any bleeding between periods or after sex?
- Has the woman has been pregnant in the past? Any history of miscarriages, pregnancy complications, births, and/or birth complications?
- Has the man has caused any conception in the past, with any partner?
- Have any member of the couple tried to conceive in the past, with a previous partner? How did that go?
- How much do you smoke? Did you smoke in the past? When did you stop smoking? How much alcohol do you drink? Do you take any recreational drugs – legal or illegal? These questions will be addressed to both the woman and the man since both sexes can have their fertility effected by these factors.
- Is there a lot of stress in your life?
- Medical history for both the man and the woman. Please remember that STI:s are far from the only medical problems that can impact fertility. Your physician needs to know as much as possible about you past and present health issues to make the best assessment of your situation. The physician doesn’t just need to know about diseases, but also about the treatments that you have received or is still receiving. That is because some medical treatments can cause short-term or long-term fertility problems. Don’t forget to mention over-the-counter drugs and alternative treatments (herbal remedies, etc).
Physical examination
After asking the questions, the physician can proceed to examining the man and the woman physically.
- Examination of the woman’s pelvic area to check for abnormalities or disease, such as infection, pelvic inflammatory disease, fribroids, endometriosis, or ovarian tumors.
- Examination of the male to look for abnormalities or disease, such as deformed testicles, testicular lumps or deformed penis.
- Weighing and measuring the man and the woman to find out their Body Mass Index.
Tests
After the physical examination, the physician can refer you for tests. Here area few examples of common tests.
Examples of tests for women
- Checking for sexually transmitted infections, such as chlamydia and gonorrhea. This can normally be done by testing your urine, or by using a swab to collect some cells from your cervix.
- If you have regular periods, your blood can be tested for the hormone progesterone at the proper part of your cycle to see if you are ovulating. If you don’t have regular periods, your blood will instead be tested for gonadotrophins, a type of hormones that stimulate the ovaries to mature eggs.
- Ovaries, uterus and fallopian tubes can be inspected during a transvaginal ultrasound scan. This makes it possible to detect conditions such as fibroids, endometriosis and blocked or scared fallopian tubes. If the ultrasound indicates a blockage, you may have to undergo further testing, including laparoscopy.
- In some cases, a hysterosalpingo-contrast-ultrasonography (using ultrasound) or a hysterosalpingogram (using x-rays) is necessary to check the fallopian tubes for blockages and other abnormalities.
- The uterus, ovaries and fallopian tubes can be inspected using keyhole surgery (laparoscopy). Through a very small cut in the stomach, a thin tube with a camera at the end is inserted by the surgeon. Keyhole surgery is only carried out if there are strong reasons for it, i.e. when an ultrasound scan has indicated that there is some form of blockage in one or both of the fallopian tubes and the doctor needs to investigate this further.
Examples of tests for men
- Checking for sexually transmitted infections, such as chlamydia and gonorrhea.
- A semen analysis can be carried out to check your sperm count, sperm mobility, etc.