Fertility Problems

Why me?

One in seven couples experience trouble conceiving - so you're not alone. It can be very distressing, so if you are having trouble then get help!

Can you explain the basics?

If you have a look at the pictures above, the basic essentials are there. The egg leaves the ovary and travels along the fallopian tube on its way to the uterus (womb).

The sperm enter the womb through the vagina and cervix (neck of the womb) and meet and fertilise the egg in the tube.

The fertilised egg then travels the rest of the way along the tube and implants in the soft lining of the womb to continue developing into a baby.

When is the best time to have sex to get pregnant?

Regular sex is the key but if you want to calculate a good day then the egg is released 14 days before your next period starts and you really want to have sperm there ready and waiting. So if you have regular periods count the number of days between the first day of one period and the first day of the next. This is your cycle length.

1st day of your period Cycle length Ovulation day Best day to have sex
Day 1 24 days Day 10 Day 8/9
Day 1 28 days Day 14 Day 12/13
Day 1 32 days Day 18 Day 16/17

What are the essentials?

  1. An egg. The ovaries usually produce one egg per month.
  2. Sperm. Good quantities of good quality sperm.
  3. Undamaged tubes. The tubes need to be open all the way along.
  4. Womb. The lining of the womb needs to be ready for a fertilised egg.

What can go wrong?

  1. Ovulation. If the ovaries are not regularly producing good quality eggs then the chances of getting pregnant are less.
  2. Sperm. If the man is not producing good quantities of good quality sperm then this again reduces the chances.
  3. Tubes. If the tubes are blocked or damaged then the sperm and egg can't meet and fertilise.
  4. Womb. If the lining of the womb is not right then implantation is less likely.
  5. Unexplained. Sometimes we just never get to work out why a couple don't conceive.

What can go wrong?

How will I know if I am producing eggs?

The cycle of hormones every month needs to be just right to develop the egg and for it to be released from the ovary. Women who have no periods or irregular periods may not be releasing regular eggs.

I have polycystic ovary syndrome, can I get pregnant?

Polycystic ovaries have cysts on them which can get in the way of regular ovulation. If this is your problem then some medication to stimulate the ovaries can help you to conceive.

How do I know if my partner is producing enough sperm?

Men's ejaculations vary quite a lot and it is impossible to tell by just looking. Your man will need to have a sperm test to see what is going on under the microscope. This is the only way to count the sperm and to make sure there are enough normal ones to have a chance of successfully fertilising the egg.

Why might my tubes be blocked?

If you have had a severe pelvic infection (eg Chlamydia) before then this can block tubes. Other things such as endometriosis can also damage tubes. If you have had an ectopic pregnancy before (a pregnancy in the tube) then this can indicate that there is tube damage.

I have had Chlamydia before, does this mean I have blocked tubes?

For a Chlamydia infection to stop you getting pregnant, it has to have caused some damage. Infections that did not cause a lot of pain, bleeding, discharge etc may not have caused any internal damage. It is when you actually had ‘pelvic inflammatory disease’ (PID) that the problems really arise.

I have been told I might have endometriosis, does this mean I won't get pregnant?

Endometriosis are small deposits of womb lining (endometrium) that grow in other places other than inside the womb. They don't mean that you won't ever get pregnant but if they damage the tubes then this can cause problems.

How do I know if I have a problem with my womb?

Womb problems are not very common. If you are having regular periods then your womb is probably OK. If you have any concern, your GP can examine your womb or get a scan done to check your womb is normal.

How can I help my fertility?

A happy and healthy lifestyle and relationship is best for helping you to conceive. This applies to the man and the woman and includes:

  • A healthy weight
  • Regular exercise (but not over-exercising)
  • Not smoking
  • Limiting alcohol intake
  • Avoid recreational drug use and check the leaflet of any medication you are taking.

What tests can I have done?

  • Period diary. If you are having regular, normal periods then it is likely that you are releasing regular eggs.
  • Sperm test. All men should have a sperm test, and if the first is a bit abnormal then have it repeated.
  • Day 21 progesterone. This is a blood test usually taken on day 21 of a 28 day cycle. It will show if you released an egg that month. The timing of the blood tests depends on your cycle length. It should be done 7 days after your calculated day of ovulation (see table above).
  • Prolactin blood test. This is an important hormone produced in the brain. A high level can cause fertility problems and needs checking out.
  • Thyroid test. You should have a blood test to check for thyroid problems which can reduce fertility.
  • Chlamydia test. Both the man and woman should be checked for infections such as Chlamydia.
  • HSG (hysterosalpingogram). This is a specialist test done in a hospital or clinic. The doctor will inject some dye into the womb and then take x-ray pictures to check that the dye is able to travel freely through the womb and tubes.
  • Laparoscopy. This is the keyhole surgery test where you the doctor would use small telescopes to look inside the abdomen and check your womb, pelvis and ovaries.

Do I need to have all these tests?

Not everyone needs all the tests. Everyone should have a period diary, the sperm test and the blood tests. The specialist tests are only needed if medical treatments have not worked or if there is real worry that the tubes are blocked or if there is suspected severe endometriosis.

What treatment is there available, I've heard IVF is very expensive?

There are four broad types of treatment according to what is wrong with you:

  1. Ovulation problems
  2. Tube or womb problems
  3. IVF
  4. Artificial insemination

Ovulation problems

If you:

  • are having infrequent or irregular periods or
  • your Day 21 progesterone test doesn't prove you are ovulating and
  • your other blood tests are normal and
  • your sperm test is normal and
  • you've never had a bad pelvic infection or ectopic pregnancy or endometriosis

Then some drug treatment to make your ovaries work a bit harder and produce an egg might be all you need. This is not very expensive and we can provide this for you.

What drugs can you use?

The diabetes drug, Metformin, used with the ovary stimulating drug, Clomiphene, can be very good at helping you produce eggs. This is recommended to use for up to six months.

What if the sperm count is low?

If the sperm test is abnormal then have it repeated to make sure it wasn't just a bad day. If there are truly not enough good sperm then the only way to get pregnant would be in a special clinic where they can either select out your partner's best sperm and inject them into your womb (artificial insemination), or sometimes they have to use sperm from a different man if there really aren't enough (donor insemination).

What if my tubes are blocked or damaged?

If both tubes are completely blocked then you can't get pregnant naturally, However, if there is any small way through then keep trying as it only takes one sperm to make it through and then for your egg to make it back along into the womb. Damaged tubes are more likely to lead to ectopic pregnancies so if you do find yourself pregnant then make sure you have an early scan to make sure the embryo is in the womb.

What about IVF?

IVF (in-vitro fertilsation) is where they take your eggs out of your body and fertilise them in the laboratory before injecting them back into your womb. This is done in specialist clinics and hospitals.

When would I be referred for IVF?

You can be referred for IVF on the NHS if you meet certain criteria. For more information visit the NHS Choices website.

Packages Available

Package 1

  • Medical history and evaluation
  • Blood tests (Day 21 progesterone, prolactin, TFT)
  • Chlamydia tests for you and your partner
  • One month treatment of Metformin and Clomifene

Package 2

  • Medical history and evaluation
  • Chlamydia tests for you and your partner
  • One-off blood test (Prolactin, TFT)
  • Monthly Day 21 progesterone to check ovulation for 6 months
  • Six month treatment of Metformin and Clomifene

Extended Screening Tests

  • Antenatal screening blood tests
  • Down's Syndrome risk profile
  • We can arrange semen analysis in some areas
Fertility consultation