Stages of Fertility investigation


I remember when I was first told I had endometriosis – I had no idea what it was; I remember putting the phone down to the nurse, googling it and saw that it could lead to infertility. At the time, I was shocked but in no place to even consider bringing a child into the world as I was single and a serious relationship was the farthest thing from my mind. I didn’t even know if I wanted children!


A year later and I had found my soulmate at last – I remember so early on in our relationship, ie. a few weeks (!) I told him that we’d need to try for kids soon as it might be difficult for me to get pregnant. The diagnosis had already planted a negative seed in my head that I might be infertile and I wonder if that was part of my eventual difficulty.


When I first came off the pill a year later just after we were married, the first few weeks of trying were exciting but I quickly got anxious that I wasn’t getting pregnant. I think if I’d understood better what was “normal” with conception and what options I had, I might have felt a bit more reassured, so I thought it would be useful to do a post on the stages of fertility investigation. This may obviously differ between country and country but broadly it should look about the same. Your doctor will be able to advise on the process specific for you, but if you’re just starting out hopefully this will give you a quick overview.


  • Preconception check up= If you’re planning for a baby, it’s generally a good idea to have a quick once over at a fertility clinic or doctor’s surgery where they might do some blood tests to assess whether you ovulate and how good your egg reserve is.


  • Getting things started!= When you’re ready to get going, remove any negativity or doubt from your mind and give yourself the best chance to try naturally! Right at the start, it’s often impossible to know how fertile you really are. Even if the doctors have diagnosed you with PCOS or endometriosis there’s no reason to assume you won’t get pregnant naturally, so give it a good shot!


  • First visit to the doctor= If you’re over 35 or have previous gynaecological conditions then it’s usually advisable to visit your doctor after 6 months of trying naturally at the optimum time of your cycle. If you’re under 35 then the advice is usually to try naturally for 1 year before starting investigations.


  • Natural support= If the doctor can’t find any obvious reason why you’re not getting pregnant (which is very often the case) they you might want to look at some natural support ie. acupuncture, reflexology, Chinese herbs, counselling which can be beneficial for conception.


  • Referral= Your doctor may refer you to a specialist gynaecologist for further tests including checking that your fallopian tubes are open (a dye is inserted and if it passes through with ease that shows that there is no blockage) and also a sperm test for your partner.


  • Scan = The next step may be an internal scan to check around the ovaries and uterus for cysts or other physical issues that might be making it hard to get pregnant.


  • Fertility clinic = At this point you may be referred, or self refer to a fertility clinic to discuss your options. If your tests or scans have picked up any issues then you can review these with the consultant to come up with a plan of action which may involve medication or surgery ie. laparoscopy in the case of clearing endometriosis or cysts.


  • Fitting the criteria = You might find that clinics in your country have certain criteria that needs to be complied with in order for them to start treatment ie. age thresholds, FSH levels and weight. This should be explained to you at your first meeting.


  • First stage medical treatments =The first line treatment may include medication like Clomid to increase/ kick start ovulation or supplements if there is an issue with the sperm


  • IUI = Your doctor may advise to move onto intrauterine insemination which involves stimulating the ovaries with medication, collecting a sperm sample and at the fertile time of they cycle, injecting the sperm into the cervix. This is usually advised for couple with male fertility issues but might not be suitable for everyone.


  • IVF = If IUI hasn’t worked for you, then IVF could be the next step. The stimulation process is similar but instead of injecting the sperm into thee cervix, the eggs are extracted and mixed with sperm outside of the uterus and then any fertilized eggs are inserted back into the uterus.


  • Donor sperm/egg = If there are known issues with either the egg or sperm or multiple treatments have been unsuccessful, then you may discuss donor sperm/eggs with your doctor as an option.



I hope that’s been a useful quick overview of the various stages of fertility investigation and as I say, there may be others that your doctor feels would be beneficial for you. I know it seems like a long and painful road but you just don’t know when your time to conceive will be – it could be stage 1 or stage 12 or not at all, but try not to assume and as far as you can, just go with the flow.

 Making a baby is a weird, wonderful, painful and incomprehensible world but you’re not on your own 😊


Speak soon


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