Fertility

The process usually starts with a detailed medical history and is followed by clinical examinations and diagnostic tests.

Commonly she will ask about your:

• menstrual cycle, pain, duration, flow.
• Sexual history: frequency, timing, contraception use.
• Pregnancy history: previous pregnancies, miscarriages, terminations.
• Medical conditions: PCOS, thyroid disorders, endometriosis, STIs.
• Lifestyle factors: smoking, alcohol, weight, stress.
• Family history of early menopause, fertility issues, or genetic conditions.

A physical and pelvic examination will follow and include an ultrasound scan to check for uterine anomalies, endometrial lining, ovarian follicles, polycystic ovaries, fibroids, cysts or structural abnormalities. A speculum examination will also be undertaken and swabs taken if necessary.

Hormone Blood Tests (done on specific days of the cycle)

• Day 2–5:
  • FSH (Follicle Stimulating Hormone): assesses ovarian reserve.
  • LH (Luteinising Hormone): checks ovulation patterns.
  • Oestradiol (Estrogen).
  • AMH (Anti-Müllerian Hormone): reflects egg supply (can be done any day).
  • TSH (Thyroid Stimulating Hormone) and Prolactin: affect ovulation.
• Day 21 (in a 28-day cycle):
  • Progesterone: confirms ovulation occurred.

Other investigations may include a hysteroscopy – to look for abnormalities and a laparoscopy and dye test to check for tubal damage and other pathology such as endometriosis.

Partners sperm test is also discussed early in the process since male factor infertility is a common contributor.

Advice on pre-conception health, weight, diet, alcohol, smoking, exercise and stress will also be discussed.