Initial Investigations - Overview
The first step in investigating a woman’s fertility is to establish whether or not she is ovulating (producing an egg) every month. This can be determined through a blood test. Ultrasound scanning may also be used to check the condition of the endometrium (the lining of the womb) and help diagnose any polyps and fibroids.
Confirming ovulation
Two hormones are responsible for the development of eggs within the ovary: Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH). The cells in the follicle also produce oestrogen and progesterone. The levels of these different hormones rise and fall depending on the stage of a woman’s cycle.
Ovulation can normally be confirmed by blood tests that measure the levels of hormones at specific stages of your cycle. Also, a transvaginal ultrasound scan can be used to visualise the follicles within the ovary and measure their size. This way, the stage of follicle development can be assessed.
Causes of infertility - Overview
There are numerous causes of infertility in women, however the three most common causes are:
- problems with ovulation
- tubal disease
- endometriosis
BLOCKED OR DAMAGED FALLOPIAN TUBES
A specialised ultrasound test called a HyCoSy may be necessary to check whether a woman's fallopian tubes are open and clear. A laparoscopy may also be recommended. In most cases, damage to fallopian tubes can be overcome through In-Vitro Fertilisation (IVF) or Intra-Cytoplasmic Sperm Injection (ICSI)
POLYCYSTIC OVARIAN SYNDROME
Polycystic Ovarian Syndrome is a common hormone problem that causes irregular periods, increased hair growth, acne, obesity and problems conceiving. There are a number of options for women with this condition who wish to conceive. These include: weight loss, insulin sensitiser medication such as metformin, ovulation-inducing drugs or IVF. Polycystic ovaries can be diagnosed during an ultrasound or with a blood test.
FAILURE OF OVULATION
Failure to ovulate is common for women with polycystic ovarian syndrome, or older women. This can be treated with either oral or injectable follicle stimulating hormone (FSH) to help ovulation occur.
ENDOMETRIOSIS
Endometriosis is where the tissue that normally lines the uterus occurs outside the uterus. This causes pelvic pain and infertility but can be treated through laparoscopic surgery. Conception can often occur naturally following this surgery.
FIBROIDS
Fibroids are benign growths that form in the uterus. They may be treated surgically if necessary.