Infertility is generally defined as the inability to conceive after 1 year of unprotected intercourse. About one in 6 couples experience this at some time. Investigations should include:

  • female blood tests for ovulation (progesterone on day 21 of a 28-day cycle) and ovarian reserve (AMH), plus more detailed tests if any irregularity in periods (eg. LH, FSH, oestradiol, testosterone, prolactin, TSH)
  • female pelvic ultrasound scan
  • female assessment of fallopian tubes (usually by HyCoSy)
  • male semen analysis

These tests are often done in conjunction with other pre-pregnancy tests such as rubella, hepatitis B & C, HIV, syphilis. Optional pre-pregnancy tests include cystic fibrosis screening and karyotype.

While any abnormalities in the above tests might lead to fertility treatment, many couples have all tests normal. The diagnosis of ‘unexplained infertility’ occurs in about 20% of couples and can be frustrating. Often it is worth further investigation such as laparoscopy (day-case keyhole surgery looking for endometriosis), and often it may reflect poor egg quality due to advancing woman’s age. Overall, 84% of couples conceive after 1 year of trying, and 92% after 2 years. So some will continue to conceive during the course of investigation. It is important to weight up the overall situation (age and time of trying) and consider effective fertility treatment such as ovulation induction, intra-uterine insemination and IVF. Some women believe there may be an immune problem preventing embryo implantation. This is relatively rare and difficult to diagnose, but Dr Sacks has pioneered the development of tests for natural killer cells which may be used in parallel with the broader assessment.’

Dr Sacks is a clinical director of IVFAustralia.

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