Fertility tests

Once your have seen your GP, and discussed the next steps, he or she can refer you to a department of reproductive medicine or a fertility clinic, or you can ask for a letter of referral to a private clinic.

There are some specific tests that all specialists will carry out and others that may be advised, and for which you may need further referral.

At the fertility clinic

Some basic tests should be done within six to eight weeks of seeing the consultant for the first time. More specialised tests will be done if necessary. There can be a wait for these, so ask the clinic what timescale to expect.

For women, the basic tests include:

• An ultrasound scan to check the ovaries and womb (uterus).
• Blood tests to check for levels of hormones involved in ovulation (egg production), such as follicle-stimulating hormone (FSH), luteinising hormone (LH) and progesterone.
• Chlamydia and rubella tests, if these haven't already been done.

For men, the basic tests include:

• A semen test to measure the quantity and quality of your sperm.

If there are no sperm or the sperm count is very low, this test should be repeated, generally within three months. About one in ten men has an abnormal sperm result on initial testing.

A clinic will not normally make a decision on the basis of a single sample of sperm because quantity and quality varies over time.

Further fertility tests

If these tests find no specific reason for why you're having problems conceiving, the woman may be offered further tests. These include:

• Hysterosalpingogram
• What it involves: a dye is injected through the neck of the womb. As it fills the womb cavity and travels into the fallopian tubes, it is viewed by x-ray.
• Used to: check if the fallopian tubes are blocked.

• Hysterosalpingo-contrast sonography
• What it involves: a vaginal ultrasound probe is used to enable the doctor to examine the womb and fallopian tubes.
• Used to: check the fallopian tubes for blockages.

• Laparoscopy
• What it involves: the doctor makes a small incision near the navel and inserts a small telescope (a laparoscope) to allow him or her to inspect the womb and fallopian tubes. A dye can be injected through the cervix to see if it runs through the fallopian tubes (laparoscopy and dye).
• Used to: check for scar tissue, endometriosis or blockage of the fallopian tubes. A laparoscopy is usually offered if you've had pelvic inflammatory disease, endometriosis or an ectopic pregnancy.

• Hysteroscopy
• What it involves: a small microscope, called a hysteroscope, with a camera attached is passed through the vagina and cervix to view the womb.
• Used to: check for fibroids, polyps or any other abnormalities.

What next?

The results of the tests should give the clinic team a clearer idea of what's causing the infertility and where the difficulty lies. At a follow-up appointment, they'll explain what the results mean and discuss any possible treatment options.

Fertility treatment is highly individualised and any decisions will depend on your particular circumstances. . For example, a couple in their 20s where the female partner appears to have no problem but the man has a low sperm count may decide to continue trying for a while without treatment because time is on their side. However, a woman in her late 30s in the same situation may want to consider opting for treatment sooner rather than later because of the natural age-related decline in female fertility.

A good relationship with the team at the clinic is vital to help reach the best decision. It's important to feel comfortable asking questions until you have enough information to make a decision.