More than 80% of couples under the age of 40 will conceive within a year if they have regular unprotected sexual intercourse. Couples who haven’t got pregnant within that time should get a fertility work up to identify if there are any medical disorders that are preventing them from conceiving. If the female partner is over 40, she should consider having an examination sooner, as fertility in women declines with age.
All women trying to conceive or embarking upon fertility treatment should take a folic acid supplement of 400ug daily for three months before commencement and for the first three months of pregnancy when the baby is still developing. Insufficient folic acid during this critical period of development can result in neural tube defects like spina bifida and anencephaly. If the woman has had a child with neural tube defects, takes medication that can affect the liver or she is epileptic and takes anti-seizure medicines, a higher dose of 5g is recommended.
Stopping smoking and drinking alcohol is also recommended as this may increase the chances of conception.
When attending for fertility screening, there are several ways to get an overall picture of a woman’s reproductive health.
Blood Tests – Blood draws for sexually transmitted infections are carried out because some STI’s can present with no symptoms but can cause infertility. Blood is also taken to test various hormone levels, for example, follicle stimulating hormone (FSH). Produced by the brain, this hormone encourages the release of eggs. If high amounts are detected, it could indicate that the woman is not ovulating or near to menopause. The anti-mullerian hormone test (AMH) can determine the quality of a woman’s eggs and be used as an estimation of her ovarian reserve.
Pelvic Examination – A physical examination can identify any infection, lumps or anatomical problems that might make pregnancy difficult.
Ultrasound Scan – An ultrasound scan can be done on the uterus, ovaries and fallopian tubes to see if there is any disease present, for instance, endometriosis – the abnormal growth of uterine lining on other areas of the body, or fibroids, non-cancerous growths. The scan will show if there are any blockages to the fallopian tubes and can be used to count the number of follicles in ovarian reserve tests or during fertility treatment. For couples wanting to have a clearer idea of when they ovulate, follicle tracking scans can remove a lot of the guess work.
Hysterosalpingogram – This is an X-ray of the fallopian tubes that uses a dye. Dye is injected into the tubes to see if it will pass through them. This can be done to confirm a blockage shown on ultrasound.
Laparoscopy – This is minor surgery in which a small incision is made in the lower abdomen and a tiny telescopic camera is inserted to examine the uterus, ovaries and fallopian tubes. As this is more invasive than other fertility investigations, it is usually only suggested when an X-ray or scan has identified a problem or when the woman has had previous infection or surgery that might have caused damage to the pelvic organs.