• the right doctor
• basal fertility testing
  • basal fertility testing - GP
  • basal fertility testing - specialist
• female symptoms
• additional tests for women
• female diagnosis
• male symptoms
• additional tests for men
• male diagnosis
• unexplained subfertility

basal fertility testing - specialist

If your general practitioner refers you to a gynaecologist or fertility clinic the first thing that will be performed or completed is a basal fertility test. Do remember that although the information your GP provided you with is of value, some tests will have to be repeated.

Most doctors and nurses who work in medical and fertility clinics are sympathetic and attentive and will do their utmost to ensure that the evaluation is as stress-free as possible. For some tests, samples from both the male and the female are needed, which will subsequently be analysed in a laboratory.

• medical history
• physical examination
• menstrual cycle evaluation / ovulation detection
• blood tests
• sperm analysis
• post coital test (PCT)

medical history

The medical history of both you and your partner will be investigated at the clinic. Generally, this involves more extensive questions than those already posed to you by your GP.

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physical examination

The woman will routinely undergo a general gynaecological examination. In addition, a vaginal ultrasonic probe may be performed in order to view the ovaries and uterus (womb).

However physical examination of the man is not routinely necessary unless indicated by his medical history or if the 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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menstrual cycle evaluation / ovulation detection

In the clinic, the growth of the follicles and eggs (ova) can be followed throughout the woman’s cycle using a vaginal ultrasonic probe. This is a painless examination during which an oblong instrument (the probe) is inserted into the vagina. Through the medium of sound waves, the reproductive structures are converted into images on a monitor, and the exact time of ovulation can be identified. The growth of the lining of the uterus may also be measured during the scan. The quality of ovulation can also be checked one week later by measuring the blood levels of progesterone. The interval between ovulation and the first day of the following menstruation also provides useful information: if the interval is too short, it is described as an insufficient luteal phase.

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blood tests

Hormone levels

Blood tests to measure hormone levels are also carried out in the woman. As different hormones play a role at different times of the cycle, a blood sample is generally taken at the start of the menstrual cycle and then again one week after ovulation. The exact moment is identified while charting the menstrual cycle.

Measuring, for example, the levels of follicle stimulating hormone (FSH), luteinizing hormone (LH) and oestradiol in the first 2 to 4 days of the menstrual cycle, allows an assessment of a woman’s ‘ovarian reserve’, an indication of the potential of the ovaries to ovulate. An increased progesterone level - seven days after ovulation is anticipated - indicates that ovulation (egg release) has taken place.

Just as with most blood tests, blood samples can be taken either in the GP’s surgery or in a laboratory, a procedure that only takes a few minutes. Women will find themselves providing a large number of blood samples for diverse tests during the first phase.

When vaginal ultrasonic probe is used to follow the menstrual cycle more closely, testing hormone levels can take place more accurately.

Women who have already undergone testing for chlamydia antibodies (CAT) through their GP will not have to have this test repeated. In males, blood tests may be needed if the results of the sperm analysis remain abnormal when the first analysis is repeated.

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sperm analysis

If the GP has already arranged for a sperm analysis, and it has not detected any abnormalities, then further examination of the male is rarely needed. If abnormalities are found, then the examination will be repeated and, if necessary, further tests will be undertaken.

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post coital test (PCT)

As stated earlier, the correct timing of a PCT is essential for reliable results. Clinics that perform this test will repeat it frequently during the menstrual cycle, to maixmise the chance of accurate timing.

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