Like most couples, you assumed you’d have a baby via natural conception. But it hasn’t happened yet, so what’s the next step?

If you’ve had your heart set on natural conception, contemplating fertility testing or even meeting with a fertility doctor probably feels like a loss. You may even find yourself putting off that enquiry week by week, thinking ‘maybe next month’s the month’. But as time ticks by and that positive pregnancy test doesn’t arrive, you realise it’s sensible to consider fertility assessment. But what does fertility consultation involve and how do you know it’s the right time? Read on to learn more. 

When is it time to see a fertility specialist?

It’s never a bad time to see a fertility doctor if you’ve been trying to have a baby without success. But good timeline guidance is:

• If you’re 34 or younger: After 12 months of trying 
• If you’re 35-39: Officially after 6 months of trying, but we suggest after 3 months
• If you’re 40 or older: Within 3 months but ideally when you decide to start trying
• If you have health conditions that can affect fertility (e.g. endometriosis, PCOS or other hormonal imbalances, autoimmune conditions etc.) it’s wise to talk to a doctor when you decide to try for a baby

Why do we give these time guidelines? Because age is the single biggest factor affecting fertility. To illustrate:

• Statistically a woman aged 30 has around a 20% chance of natural conception each month
• By the time she is 40, that figure falls to 8.6% (and her risk of miscarriage is much higher)
• Age affects assisted conception outcomes too

So the key point is: If you do need some form of fertility treatment to help you conceive, the sooner you know about it the more likely it is to be successful. If testing shows no issues, great! You can enjoy some peace of mind. 

Is it worth getting a fertility test and am I giving up on natural conception?

Dr Bhaskara Kale, Fertility Consultant says: “Sometimes when we’re trying for a baby, there’s a strange kind of superstition about going to see a fertility doctor. As if it’s giving up on natural conception or will somehow make it less likely. But the data doesn’t tell that story.”

For example:

Research has now revealed that even among women who have given birth through assisted conception, 1 in 5 have then later had a natural conception. 

Getting a fertility assessment gets rid of the nagging, niggling thoughts like: 

Is there something wrong with my fertility?

Will I be able to conceive naturally?

Could it be XYZ?

Let’s face it, if you’ve been trying for a while with no joy, those fears are there whether you try to push them away or not. Many women say that the unknown starts to create hidden stress. And when it comes to trying for a baby, anything we can do to ease stress is always a good thing.

Getting a fertility check enables you to focus on the things you can control, instead of worrying about problems that may not even exist – and if they do exist, you can’t address them as long as you remain in the dark. 

Remember that a fertility assessment is just fact-finding. Seeing a fertility doctor in itself doesn’t mean you’re going to need or choose fertility medicine. And if you do turn out to opt for fertility medicine, there are lots of less invasive solutions that exist – from fertility medicines to immune treatments. It isn’t necessarily all about IVF. 

A fertility consultant can advise you regarding:

• The importance of age.
• Understanding of your reproductive health and any issues potentially affecting natural conception.
• How to improve the chances of natural conception like fertile period, healthy body weight, lifestyle factors, optimising underlying medical conditions etc.
• Improve your knowledge about fertility.

Seeking advice from a fertility specialist does not commit you to treatment. It should not be viewed as abandoning the possibility of natural conception.

What to expect in a fertility consultation? Read on.

What happens in a fertility consultation?

If you meet with a good fertility doctor you can expect:

• Medical history taking
• Lifestyle advice 
• Testing recommendations

Consultation with a fertility specialist involves thorough medical history taking. Your fertility (and even fertility testing itself) can be impacted in numerous ways through all sorts of underlying health conditions, medications and lifestyle factors that might seem completely unrelated. A good fertility doctor will ask a series of exacting questions before providing advice specifically tailored to you, and that includes testing recommendations.

What does fertility testing consist of?

You can either start with an initial consultation or pay for a testing package upfront. Here at The Fertility and Gynaecology Academy we do provide standalone testing options – but we  recommend comprehensive packages because it’s more cost-effective and it gives you a much more accurate picture of where your fertility is than a ‘bits and pieces’ approach. 

A comprehensive fertility testing package at a good fertility clinic should include:

Thorough consultation

This should be an in-depth conversation where a fertility expert covers:

• Medical history taking
• Lifestyle advice 
• Testing recommendations

This is where the puzzle work starts. They will be looking to identify any factors that could be affecting your fertility. To make the most of your appointment, it’s a good idea to write down any questions or concerns ahead of time. 

Transvaginal ultrasound 

Here doctors can see and count your antral follicles (which hold your immature eggs). They will also assess your reproductive organs to help identify problems that could be affecting your ability to conceive (e.g. cysts, fibroids, issues with womb lining).

Blood testing

This helps determine your ovarian reserve (how many eggs you have left). We can also employ blood testing to help ascertain the general balance of other hormones that are key to your fertility.

Saline Hysterography (SIS) aka Aqua Scan 

This is an ultrasound in which we gently administer sterile saline into the uterus with a catheter to get a more thorough picture of the womb’s interior and a clearer view of any fallopian tube blockages. 

Semen analysis for the male partner 

Many people don’t realise just how vital fertility testing for men is. Male subfertility alone makes up 30% of all subfertility in heterosexual couples – and a further 30 to 40% when combined with female subfertility or that of unknown cause.

Semen analysis should encompass sperm count, motility, shape, and the overall content of the seminal fluid. In addition, elite screening can check for antisperm antibodies if suspected (immune system proteins that misidentify sperm cells as invaders and attack them). 

Explanation of the results in person and in writing 

A comprehensive fertility package at a good fertility clinic will conclude with:

• A detailed, plain-language breakdown of the results in person by a compassionate fertility expert 
• Space to ask all your questions and talk through your options 
• An in-depth written report to take away with you so that you can return to it as you figure out what’s next