If you’re eager to have a baby and have not achieved a successful pregnancy after 12 months of regular unprotected sex if you’re under age 35, or after six months of unprotected sex if you’re older than that, it’s important for you and your partner to have a fertility evaluation by a specialist.
“However, if you or your partner have known problems that may affect your fertility, then see a fertility specialist before you try to fall pregnant,” says Dr Antonio Rodrigues, reproductive medicine specialist and director of Medfem Fertility Clinic in Gauteng.
Many factors can affect fertility, and in a third of cases the challenge is due to the female partner, while in another third it’s due to the male, and in the remaining third it’s a combination or male and female issues, says Rodrigues.
At the evaluation you can expect a thorough review of your medical history: The specialist will ask about your sexual activity, particularly the frequency and timing of intercourse, and about lifestyle issues that can affect fertility – smoking, drug and alcohol use, caffeine consumption and any medications you have been taking, as well as your general medical and emotional health.
They will need to know about the menstrual history of the female partner, ejaculation or other sexual issues of the male partner, any genital trauma or infections either of you may have had, previous pregnancies and their outcomes, and your family histories, including members with infertility, genetic mutations, birth defects or mental retardation.
Infertility tests will follow.
For the woman
The most common causes of infertility are advanced age, abnormal thyroid function, anovulation (when your ovary doesn’t release an egg during your menstrual cycle), blocked fallopian tubes, cervical problems, diminished ovarian reserve (having fewer eggs in your ovaries compared to most women your age), endometriosis, polycystic ovarian syndrome, stress, and uterine problems. Tests can be done to help pinpoint which of these may be at play.
Blood will be drawn to test for hormones to evaluate ovulation function and egg quality, and levels of prolactin and thyroid function. These tests may need to be done at certain stages of your menstrual cycle, requiring you to attend clinic on another day.
A pelvic ultrasound examination will usually be done to evaluate your uterus and ovaries, and check for fibroids, ovarian cysts or benign tumours, says Rodrigues.
A hysteroscopy examination may be done of the inside of your cervix and uterus, using a thin, lighted, flexible tube (the hysteroscope), to detect fibroids, polyps, a uterine septum, or scar tissue or blockage at the opening of the fallopian tubes.
A hysterosalpingogram (HSG) procedure may be performed, where dye is injected into the uterus and can be visualised with an X-ray, to help assess causes of infertility – “specifically to assess whether the fallopian tubes are open”, Rodrigues says.
Or a laparoscopy procedure may be done, where a tiny camera is inserted through a keyhole incision in your naval to detect problems such as adhesions (scar tissue), endometriosis or ovarian cysts.
For the man
Male infertility can be caused by problems with sperm, the testes, the ducts leading from the testes, functional problems related to sexual activity, hormone problems or genetic problems, says Rodrigues. But the common causes are sperm disorders.
Tests will include taking blood to test for fertility-linked hormones, and a semen analysis. You will be required to produce a semen sample, and analysis will measure the amount of semen produced, the number and quality of sperm, their concentration, motility (movement), morphology (shape), and the presence or absence of antisperm antibodies. (Antisperm antibodies fight sperm; they occur when the immune system mistakenly targets semen as an invader and damages or kills it; both men and women can make these antibodies, but it’s uncommon.)
It’s best to trust fertility evaluation to a fertility specialist with extensive experience and access to advanced techniques and equipment. Ask your health provider for a referral. Remember to take all related medical records, a list of any medication, vitamins or supplements you may be on, and a list of questions to ask.
Depending on the diagnoses from your evaluation, the specialist will draw up a treatment plan. This may include lifestyle modifications, fertility medications or surgical interventions, and possibly intrauterine insemination or in vitro fertilisation.
Also read: Should you be worried about infertility?
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