Investigations
In order to find out why a couple are not conceiving we usually advise number of investigations. Our aim is to do this in the least invasive way and with any delay. In the woman we need to check whether an egg is being released each month. This is best done by measuring the hormone progesterone 7 days after ovulation has occurred (test of ovulation). Because egg numbers decline with age we also need to look at the quantity and quality of the eggs left in the ovary (ovarian reserve test). We also need to evaluate whether the fallopian tubes are open and functioning normally. This requires a test of tubal patency which can either be done as an X-ray (hysterosalpingogram) or by using key-hole surgery at laparoscopy. In the man we need to know if there are sufficient sperm numbers and whether they function normally by getting a semen analysis.
When couples attend clinic, we recommend both the man and woman are investigated as this avoids unnecessary delay with diagnosis. This is because in 40% of cases we find the infertility is due to a female factor, in a further 40% it is due to a male factor and in the remaining 20% a combined problem is identified.
In same sex couples, or single women requesting donor insemination, we only need to investigate the female partner undergoing treatment. We do however request that both women in a couple receive counselling. If the sperm is from a known donor then the man will also need to attend for investigations and counselling
All patients undergoing assisted conception treatment involving the use of prepared gametes (eg IUI, IVF and ICSI) need to be screened for HIV, hepatitis B and C prior to embarking on treatment.
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