1.When should I seek treatment?
Most doctors would advise a couple to seek advice if they have been actively trying to conceive for more than a year. If there are any specific problems, such as irregular periods, or if the woman is older, more than 35, they should seek advice earlier.
2.What specific tests would you recommend to diagnose infertility?
Firstly, the couple should be aware of the woman’s menstrual cycle – is it regular, what is the fertile time of the month. They can test for this using ovulation kits that are widely available in pharmacies and supermarkets. Once they see a fertility specialist, there are some basic tests that will be done first:
- A sperm count (semen analysis) for the man
- Blood tests for the woman, to check her hormone levels
- An ultrasound scan of the woman’s uterus and ovaries, and a check of her fallopian tubes, to see if there is any anatomical problem
- Other tests may be needed in particular circumstances
3.What are my ‘ovarian reserves’ and how does this determine my fertility? What tests can I do to measure this?
Women are born with a finite supply of eggs and, as they get older, the supply gradually reduces. Usually, the supply doesn’t finish until she is well into her forties but sometimes this happens earlier than expected. The doctor can check the egg supply, or ovarian reserve, by measuring a hormone known as AMH (anti-Müllerian hormone) and by performing an ultrasound scan of the ovaries during a period, to check the number of small egg-containing follicles that are present (antral follicle count).
4.Does smoking, drinking or other lifestyle related factors affect my fertility?
Undoubtedly. Women who smoke regularly have a reduced ovarian reserve and their eggs tend to be of poorer quality than those from women who have never smoked. This is also true for regular heavy consumption of alcohol. These women, if they do get pregnant, also have more complicated pregnancies and their babies are less healthy with lower birth weights.
5.Should I consider genetic testing?
Genetic testing of embryos during IVF treatment is certainly of benefit if there is a specific disease that runs in the family and it is known that a couple have an increased risk. Many diseases can be detected this way, but not all. There are many conditions where genetic diagnosis is not possible, so it is important to discuss this issue with your doctor.
Some couples would like to be reassured that their baby will be healthy and genetic testing of an embryo may help with this. For example, older women, more than 35 are more likely to deliver babies with genetic problems such as Down Syndrome, and this can be picked up by genetic testing, so that the problem is avoided. It may also be useful for women who have previously experienced a number of miscarriages and increase their chance of having a successful pregnancy.