When to Get Help

Many people continue trying to conceive naturally for a long time before they get help. Knowing when to get help is key to ensuring you get the right investigations and treatments at the right time. We cover all of this in more detail in The Fertility Book: Your Definitive Guide to Achieving a Healthy Pregnancy. In this section we look at:

• Do I need to see a doctor about my fertility?
• First steps
• Infertility clinics
• Do I have to pay for fertility treatment?
• How your age affects when you should get help
• Weight and fertility treatments
• You might need help sooner if…
• A shared process

Do I need to see a doctor about my fertility?

There are certain preconception screening tests that are recommended for everyone planning a pregnancy including a sexual health check and a test for rubella immunity if you are to carry the pregnancy. So we recommend seeing your GP about this when you first start trying to conceive.

Thereafter, you can start trying to conceive naturally if you’re in a heterosexual relationship. If you’re single or in a same sex relationship and need sperm or egg donation, you should be referred to your local fertility clinic after the appropriate preconception screening. As a general rule, you should seek advice if you have been trying for a baby for more than a year and are having problems conceiving. If you have irregular periods or a past history of a pelvic issue, then you might want to seek help earlier. Also, if you are in your late thirties or forties it is worthwhile getting checked as soon as you decide to start trying.

For most people the term ‘subfertility’ is more appropriate than ‘infertility’ as the vast majority of people attending fertility clinics have the ability to conceive naturally, it is just taking longer than it should and help may be needed. You can find out more about your fertility and any problems you may be experiencing in The Fertility Book: Your Definitive Guide to Achieving a Healthy Pregnancy.

First steps

Start by making an appointment with your GP to discuss your fertility and ask if any of the doctors in your practice have an interest in reproductive medicine and women’s health. You may initially be seen by one of the nurses rather than the doctor – this doesn’t matter as long as you see someone who understands what tests are required and when they should be done. Often, blood tests to measure hormones are taken at the wrong time in a woman’s cycle and this makes all the difference when interpreting the results. You can also ask to be referred to the specialist infertility clinic at your local hospital.

Infertility clinics

Depending upon the size of your nearest hospital the clinic may be run by a gynaecologist with a ‘special interest’ in infertility or a team of reproductive medicine specialists. If your local hospital is relatively small then the clinic may be limited in what it can offer and you may be referred to a larger reproductive medicine service, which will usually be in a teaching hospital.

Infertility clinics are usually run by obstetricians and gynaecologists, who are specialists trained in all aspects of women’s health and the care of women during pregnancy. Some gynaecologists have additional qualifications and accreditation in reproductive medicine, which requires several additional years of training in order to be able to manage more complex problems and provide treatments such as in vitro fertilisation (IVF). Specialists in reproductive medicine are also trained to know how to investigate and manage male fertility problems, even if their main qualification is as a gynaecologist, so don’t worry if you see a specialist and there are problems on the male side. If the male partner needs surgery or more complex treatments then you may also be referred to an andrologist, who is usually a urologist (a consultant who deals predominantly with kidney and bladder problems) with a special interest and training in male fertility. All large reproductive medicine centres should have access to an andrologist.

Fertility treatment can be complicated and it’s helpful to understand the investigations and treatments you may need so that you can participate in your medical care and ensure you are getting the best treatment for you. We cover all of this in much more detail in The Fertility Book: Your Definitive Guide to Achieving a Healthy Pregnancy.

Do I have to pay for fertility treatment?

In the UK you should be able to access initial investigations through the NHS. There are, however, eligibility criteria for NHS-funded fertility treatments and these vary around the UK and may depend upon factors such as your age, body mass index (BMI) and whether you or your partner have children already. Unfortunately, there is what’s known as a ‘postcode lottery’ which we have been campaigning to abolish for many years. It’s important to find out what your local eligibility criteria are so that you know where you stand.

If you are not eligible for NHS funding then you will have to self-fund. Most NHS reproductive medicine centres will also provide self-funded (or ‘private’) care and so you won’t necessarily have to go to a private clinic. In the UK the Human Fertilisation & Embryology Authority (HFEA) licenses all IVF clinics and provides information on success rates in order to help you to make a choice. Of course, where you live will also make a difference as it is important to choose a clinic which is easily accessible as most fertility treatments require many visits to the clinic.

Facilities for fertility treatment and funding criteria vary around the world and so if you don’t live in the UK it’s important to check out your local situation.

How your age affects when you should get help

If you are a woman who has reached her 35th birthday and has not conceived after trying for a year, don’t delay seeing your doctor beyond this. It may take a year or so before you realise that you may have a problem, a few months to be investigated and referred to a fertility clinic, and then, if you need additional testing or treatment, time will have marched on. Unfortunately, the chance of any treatments working will decline with age as well.

As a general rule it is thought that a woman is extremely unlikely to have fertile eggs in the five years before she goes through the menopause, and in the five years before that her fertility will be significantly reduced. There are always exceptions of course. Furthermore, while IVF can be used to try to improve fertility it cannot enhance the fertility potential of the eggs. This is why the chance of conceiving with IVF drops rapidly from about the age of 37, is very low during a woman’s early forties and simply doesn’t work over the age of 45. Many high-profile cases of celebrities having babies in their late forties and even older will be as a result of using donated eggs, although this isn’t usually spelt out in the media articles that publicise these reports.

We cover all of this in much more detail in The Fertility Book: Your Definitive Guide to Achieving a Healthy Pregnancy.

Weight and fertility treatments

Being over- or underweight can impact general health and fertility for men and women. Women who are overweight respond less well to drugs that are used for ovarian stimulation for the treatment of both anovulation and assisted conception, although this does not always equate with a reduction in ongoing pregnancy rates. Following a healthy diet and lifestyle in the preconception period to optimise general health is important regardless of weight, so don’t lose heart if you struggle to lose weight. Focus on being the healthiest you and seek support if you would like to lose or gain weight.

You might need help sooner if…

Although guidelines for the investigation of subfertility say that a couple should have been trying to conceive for at least 12 months before any tests are done, it’s really important to recognise whether there might be a problem and seek help sooner if needed. Remember the oral contraceptives can mask symptoms, so if you’ve been taking the pill, pay attention to your periods when you come off it. You may only realise there could be a problem when you start trying to conceive and it doesn’t happen straight away. However, there are certain signs that may suggest an issue and it is important to be aware of this so you don’t lose time, especially if you are getting older.

Issues that may suggest the need for earlier investigation for women include:

• having irregular cycles
• painful periods
• a history of sexually transmitted infection (STI) or pelvic infection
• previous major surgery in the abdomen or pelvis, or a history of pregnancy problems (such as miscarriage or ectopic pregnancy)

For men:

• a history of STIs
• a history of problems with development of the testes
• surgery on the testes
• surgery for an inguinal hernia
• a history of mumps after puberty

You are entitled to have issues investigated even if you have not been trying to conceive for a year.

Your medical assessment will start with a series of basic investigations for both partners. What happens after that will depend on the results of your investigations. You can find out about your medical journey in much more detail in The Fertility Book: Your Definitive Guide to Achieving a Healthy Pregnancy.

Once the decision has been taken to start investigations it should be possible to:

• perform basic screening tests within a month or two
• provide a management plan, which may involve reassurance, more detailed investigations or treatment

A shared process

If you’re part of a couple, we encourage you to attend the clinic together. Even if only one of you is providing eggs or sperm to the treatment or will carry the pregnancy, having the moral support as you navigate your fertility journey is important at what can be a challenging time.

We cover all of this information in much more detail in The Fertility Book: Your Definitive Guide to Achieving a Healthy Pregnancy.

References

1. Adam Balen and Grace Dugdale. The Fertility Book: Your Definitive Guide to Achieving a Healthy Pregnancy. Penguin Random House (Vermilion) 2021

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