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basal fertility testing - GP

Clear arrangements have been made in the UK concerning the roles of the general practitioner (GP) and the gynaecologist when it comes to managing reduced fertility. These arrangements include both diagnosis and the policy of referral (including referring back) between the GP and the gynaecologist.

As a general rule, a basic fertility examination will be undertaken for couples with reduced fertility. The following section outlines the components of the basic examination that can be performed by the GP.

Be aware that if the results of initial tests are normal – and depending on the age of the woman and the length of time the couple have been trying for a child - some time may still be allowed without further investigation or treatment to give spontaneous pregnancy a further chance.The rationale for this approach is that it is possible that a couple may have low normal fertility rather than reduced fertility per se.

questions for the female

These questions are designed to gain a deeper understanding of your gynaecological and general medical history. They will include questions regarding your age, the length of time you have been trying to have a child, earlier pregnancies or fertility treatments, your menstrual cycle, previous infections or operations and your sex life, as well as less obvious questions. These questions will, in particular, concern characteristics that might indicate a hormonal disorder. Questions will also be asked concerning your family, as hereditary (genetic) factors can also play a role in fertility problems. There will also be questions about your lifestyle.

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questions for the male

The most important questions will be in regard to your overall health, earlier infections, accidents or operations and whether you have a family history of fertility problems. Your job and lifestyle will also be discussed in order to identify possible causes for reduced fertility.

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physical examination

The woman will routinely undergo a general gynaecological examination. However physical examination of the man is not routinely necessary unless indicated by his medical history or if an initial semen analysis result is abnormal. If this is the case, he will undergo a general physical examination with an emphasis placed on the reproductive organs.

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basal temperature curve

If a woman has a very regular menstrual cycle, then it is reasonable to assume that she ovulates halfway through her cycle. If you have kept your own temperature charts at home, then it is a good idea to show them to your GP for analysis. If you have not done this, your GP might ask you to measure and chart your basal temperature on a daily basis in order to achieve more clarification regarding the occurrence (or not) of ovulation. It is wise to record this data over a month-long period. Your GP can provide you with a special BTC (basal temperature curve) chart and accompanying instructions.

A menstrual cycle is generally regarded as ovulatory if the temperature rises approximately 0.3 degrees (or more) in the second half (the luteal phase) and remains at that temperature for at least 12 days (this is called a bi-phasal BTC). A repeat is only necessary if the BTC cannot be assessed. Aside from checking for the slight temperature rise halfway through the cycle (an indication of ovulation), it also shows the length of the cycle, and can offer the female insight into her fertile days. To fully confirm ovulation, other tests (such as ultrasonic examination and determining hormonal conditions) are necessary.

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examination for STDs

Given that sexually transmitted diseases (STDs) are widespread and can reduce fertility, an examination for STDs is one of the first steps a doctor undertakes when conducting fertility tests.

Your blood will be examined for antibodies against chlamydia: the so-called CAT (Chlamydia Antibody Titre). A positive result means that at some point you have come into contact with this infection. If it appears that you have antibodies, then this is a reason to undergo further tests to see if infection might have caused any damage to, for example, your fallopian tubes. An infection that is still active will also have to be treated.

The presence of an active chlamydia infection is checked by taking and testing a sample of cervical secretion. If positive, then both you and your partner will have to take antibiotic treatment to eradicate the infection. Both partners must be treated; otherwise they may continue to infect each other. In males, chlamydia can infect the epididymis (where the sperm is stored) and interfere with its functioning, reducing the quality of the sperm. This disorder, known as epididymal inflammation, causes the testicles to swell during the infection, and in some cases can lead to sterility. (Sterility means that even with treatment, an individual would be unable to conceive a child.)

Your doctor might also test you for other infections such as ureaplasma and mycoplasma. Alternatively, some doctors may prescribe a short course of antibiotics to treat a potential STD in order to overcome the inaccuracies of tests for specific infections.

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examination of sperm

A sperm analysis is carried out routinely in the male for any couple experiencing fertility problems. Even if demonstrable factors have been identified in the woman, it is still a good idea to find out whether or not the sperm is normal. The male receives special instructions for this. If the analysis of the semen results is normal, then further examination of the male is limited. If the result shows a low sperm count or other problems, it will be repeated - one poor analysis result is not sufficient to make a diagnosis of sperm disorder. Further examinations of the male may subsequently be undertaken.

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post-coital test (PCT)

Cervical mucous is the secretion produced by the cervix of the female. It is normally thick to keep infection out of the uterus. However at the time of ovulation (egg release), it normally becomes thin and watery to ease the passage of the sperm cells from the vagina to the uterus.

The post-coital test assesses cervical mucous around the time of ovulation to identify possible reasons why successful fertilisation is not occurring. It provides information regarding the production of cervical mucous, the sperm cells’ potential to survive in the cervical mucous and the interaction between the sperm cells and the cervical mucous. In an ideal scenario, the sperm cells move effortlessly through the cervical mucous. (The test is sometimes referred to as the Sims-Huhner test, after the doctors who invented it.)

The removal of the cervical mucous is painless and takes place in the GP’s surgery. This test must be carried out around the point of ovulation (egg release) and between two and eight hours after intercourse. Timing is critical. Using a speculum, some cervical mucous is carefully removed from the woman’s cervix, and assessed for quantity, consistency and acidity. Through a microscope, the number of sperm cells and their motility is also examined.

There is no general agreement concerning the significance of this test. It is not therefore used in all clinics.

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