We take an uniquely integrated approach to improving your natural fertility, looking at important lifestyle factors such as diet, nutrition and stress as well as doing a medical work-up with one of our specialist fertility doctors, if this is appropriate.
In our experience, too many couples who have had problems getting pregnant move too quickly into IVF without having had a thorough review of their fertility history and all-round reproductive health first. What this entails will differ from couple to couple and will depend on what, if anything, you have had done already, but it will often involve a number of critical tests and checks which, in conjunction with our assessment from your initial consultation, can help confirm whether it is sensible for you to keep trying naturally.
Step 1 may be a series of blood tests for the female partner. These will usually include an AMH and an FSH test (AMH is a substance produced by the ovaries.The level of AMH correlates to ovarian reserve, which declines with age. FSH is another ovarian predictor, which measures the responsiveness of the ovaries), along with your levels of LH, Oestradiol, Prolactin, Vitamin D, Thyroid, FBC and mid-luteal Progesterone. We will often run a detailed analysis of the male partner's semen (many NHS tests can often prove to be inadequate) at the same time.
Step 2 may be for the female partner to have an antral follicle count scan as well, which can be used alongside the AMH test to help estimate your ovarian reserve (the more visible follicles, the more eggs you are likely to have).
Step 3 would be a review of all the results, from which we would be able to formulate a forward path for you. This might involve simply taking more time to try naturally - but often in a more focussed and prepared way (which could, for example, involve some fertility awareness training to help you map your fertile times precisely) - or a treatment or treatments to overcome identified problem areas. Sometimes we might recommend a cycle of stimulated super-ovulation, using Clomid or gonadotrophins, or a round of IUI (intrauterine insemination) with stimulation. Or sometimes a cycle of mild IVF (an IVF cycle, but with a lower drug regime), which we have found gets better results for some women.
Whatever we do recommend you can be sure that it is what we believe is the most natural and least invasive way forward for you.
There are a number of other tests that we may also use prior to the start of any treatment, in order to check for tubal patency (openness) and to look in more detail at the other reproductive organs for possible anatomical problems that may be interfering with your ability to get pregnant.
The simplest test to check a woman's tubes is with an X ray and dye test called a hystero-salpinogram or HSG (hyster = uterus; salpinges = tubes). The radio-opaque dye is inserted through the cervical opening, so this is similar to having a smear test. The x-ray pictures give an outline of the womb and tubes. The HSG can identify areas of adhesions (scarring), polyps and fibroids, as well as congenital abnormalities. The dye may show up blockages anywhere along the tube. The dye itself may clear very minor blockages and some women will conceive purely as a result of this procedure.
We also use a similar, slightly more sophisticated test known as a HyCoSy. This stands for hystero-salpingo-contrast sonography and uses an ultrasound scan and contrast medium to get a more detailed image of the womb, ovaries and tubes. The test is used to check for polycystic ovaries, fibroids, polyps and other problems in the pelvis, as well as checking that the tubes are patent.
Some women may need a laparoscopy and dye test. This is a more invasive investigation, but it is often considered the "gold standard" test. It is usually performed if a woman has a history of pelvic surgery (such as an appendicectomy), pelvic pain or other symptoms, or if an HSG highlights a possible problem. A laparoscopy requires a general anaesthetic and two or three very small incisions - one around your belly-button and one or two lower down either side of your pelvis (lower abdomen). A small instrument known as a laparoscope is used to take very detailed photographs. Laparoscopy has the advantage of being able to look all around at the outside of the tubes and womb to check for adhesions (scarring) and endometriosis. In order to get a good view of your insides, we first use carbon dioxide gas to inflate your abdomen. A dye is usually passed through the inside of the tubes to check they are open (patent). An exploratory laparoscopy gives us the opportunity to treat conditions such as endometriosis or adhesions at the same time. A hysteroscopy may be performed at the same time as laparoscopy.
This involves inserting a very narrow endoscope through the cervix to view the uterine cavity. It is not normally done in the first round of any investigations, but may be suggested to provide a more detailed view of the size and shape of the inside of the womb and to get a particularly detailed view of the endometrium (lining). This may be suggested prior to IVF and is usually done under a general anaesthetic. Hysteroscopy also allows us to diagnose or treat conditions such as polyps, fibroids, adhesions or a congenital septum.