As a Gynaecologist working at a Fertility Centre, I sometimes encounter couples who approached me and ask: “Can I have an Intrauterine Insemination (IUI) treatment or In-vitro Fertilization (IVF) Treatment NOW?” My next question to them would be: “Have you had your Fertility checked and whether your doctor had identified any problems which inhibit you from having a pregnancy naturally?” Many times the couples would shake their heads or looked blankly at me. Most of the time, they would find it surprising that I pose such a question to them.
The reason this question is relevant is beacuse the types of Fertility Treatment is very much dependent on the cause of subfertility. Sometimes, a small change in the lifestyle and diet can help the couple achieve a pregnancy without going through sophisticated Fertility Treatment. However, it is important to identify those who suffer from Fertility problem which required sophisticated Fertility treatment, for example, women with blocked Fallopian tubes. This group of women would need to go through In-Vitro Fertilization (IVF) to achieve a pregnancy. Intrauterine Insemination (IUI) will not achieve a pregnancy in this scenario.
Fertility Assessment sounds scary and daunting for most people. Many would imagine that it takes complicated procedure to achieve that and therefore they procrastinate in coming to see the doctors. Some couples feel ashamed that they cannot achieve a pregnancy on their own and coming to seek help from a Fertility Specialist is a social taboo. Some couples feel frustrated because even all the test results come back normal and they still could not achieve a pregnancy naturally.
(1) What to expect when I see a doctor to check my Fertility?
To assess ones’ fertility, it is important to see a doctor who has special training in Fertility or has a special interest in fertility. It would be ideal for you and your partner to be present at the initial consultation so that your doctor could go through your history.
The doctor will check your relevant details such as regularity of menstrual cycles, previous pelvic infections or operations, frequency of sexual intercourse and etc. A gynaecological examination is done to pick up any abnormality which may be a factor for subfertility. Subsequently, the doctor will perform some investigations to determine your fertility status.
(2) What are the fertility tests which I need to go through?
To achieve a pregnancy naturally, there are four basic factors which are important. A couple would need good sperms, good eggs, a healthy uterus and at least one healthy fallopian tube. Therefore, most of the fertility tests are designed to check on these factors.
(a) Test for the female partner
Your fertility specialist will start with an ultrasound scan of the pelvis to visualize the uterus and ovaries. This scan is usually done during your menstruation. Any abnormalities of these organs will easily be seen and if relevant, be acted upon. Your fertility specialist will visualize your ovaries to count the number of follicles present in the ovaries. Along with a blood test (which includes hormonal levels), these tests aim to assess your ovarian reserve, a term used to describe your fertility potential. A fertile woman generally has a good numbers of follicles in her ovaries and the number declines with age. The commonest hormone measured is called Follicle Stimulating Hormone (FSH). A high level of FSH indicates that the eggs are few and therefore a reduction in fertility.
An ultrasound scan to visualize the ovaries and count the number of follicles
Subsequently, another ultrasound scan around the time of ovulation may be performed to assess the receptivity of the lining of the uterus (endometrium). This test is important to exclude any problems that may interfere with the implantation of the embryos e.g. polyps or fibroids, which in turn leads to subfertility.
An ultrasound scan to visualize the lining of the endometrium
If the sperm count of your male partner is normal, your fertility doctor would advise you to check the patency of your fallopian tubes. There are two common tests for tubal patency. Your fertility doctor would advise you to go through either a hysterosalpingogram (HSG) or a laparoscopy. There are advantages & disadvantages to each procedure and your doctor will recommend the one most suitable for you.
An image of Hysterosalpingogram (HSG)
(b) Test for the male partner
A sperm test is best done after 2-5 days of abstinence from sexual intercourse. This test gives us an idea whether the sperm is adequate in quantity and quality.
After the tests are completed, your fertility doctor would be able to advise you on the way forward. Although these tests take time, but with a little planning, everything can be completed within a month and you’re ready to commence on your road to a baby!