At the initial consultation, the doctor will discuss fully the nature of your fertility problems, the treatment options available, and whether a further assessment is needed prior to starting treatment.
Many couples referred to our Unit have undergone extensive infertility tests elsewhere. We will only repeat these tests if we think it is absolutely necessary to do so.
If no previous assessment of tubal patency and the uterine cavity has been performed we may recommend that a laparoscopy and hysteroscopy are performed as a Gold Standard for assessing the pelvis (see endoscopy surgery). This will give us more detailed information about the ovaries and uterus than can be obtained with a pelvic ultrasound scan. It may also enable treatment of conditions such as endometriosis or scar tissue (adhesions) or uterine polyps and fibroids. An alternative procedure to assess tubal patency is a hysterosalpingogram (HSG) in which dye is passed through the cervix into the uterus and fallopian tubes under X-ray control. This procedure may also show abnormalities in the uterus. Another test which can be recommended is a contrast scan. This may be carried out prior to commencing a treatment cycle and will identify any uterine abnormalities. If you have had any of these procedures performed recently, it may not be necessary to repeat them.
Before starting treatment, the following tests are required:
- FSH - Follicle Stimulating Hormone, LH - Luteinising Hormone, Oestradiol, Prolactin and AMH - Anti-Müllerian Hormone on day 2-5 of the menstrual cycle.
- TSH - Thyroid Stimulating Hormone if applicable.
- HIV/Hep B & C (both partners).
- Rubella.
Other tests that may be required include:
- Blood group and assessment of the blood profile for those women at risk of conditions such as sickle cell anaemia and thalassaemia.
- Day 21 progesterone levels.
- Anti-phospholipid antibodies (APA). This is for women with a history of miscarriage who may have elevated levels of APA.
- Blood group and CMV IgG and IgM for women considering treatment with donor eggs.
A transvaginal ultrasound scan may be performed on the day of your consultation
If you have recently had a scan elsewhere and can bring the report of this with you, or should you not wish to have a scan performed when you attend, please call the unit and inform the IVF reception staff of this.
If you do not wish to have a scan prior to your consultation you do not, of course, have to do so. If you need a scan thereafter we will organise this for you, of course.
The scan can be performed on any day of your cycle - it does not matter if you are having a period at the time.
HSG is an X-ray based technique used as an alternative to the gold standard of laparoscopy and hysteroscopy for assessing tubal patency and the uterine cavity. It is performed as an outpatient, without anesthetic, in the X-ray department. The test should be booked within the first half of the menstrual cycle before ovulation.
An HSG usually causes mild or moderate uterine cramping for about five minutes; however, some women may experience cramps for several hours. The symptoms can be greatly reduced by taking medications used for menstrual cramps at the same time as the antibiotics 1-2 hours prior to the procedure.
Antibiotics are given to minimize the risk of a patient developing a pelvic infection after HSG, which is an uncommon complication (the risk is less than 1%).
The chance of pregnancy after either HSG or laparoscopy to check tubal patency may be slightly higher in the 2 or 3 cycles after the test.
Diagnostic laparoscopy and dye and hysteroscopy
The gold standard investigation for assessing the female pelvis, tubal patency and uterine cavity is laparoscopy and hysteroscopy with a dye test. This is a day case operative procedure which is performed in the operating theatres at the Hospital under general anaesthetic.
A small (5mm diameter) telescope (laparoscope) is inserted through a tiny 1cm incision inside the umbilicus (tummy button). A second 1cm incision in the bikini line is used to introduce an instrument to enable the uterus, ovaries and tubes to be examined carefully. Dye is injected through the cervix and the tubes are examined to see if they fill with dye and are open to allow dye to pass through into the pelvis.
Laparoscopy also enables a diagnosis of endometriosis to be made if this is present and can see whether there is any scar tissue (adhesions) around the tubes or ovaries. It may be possible to treat these at the same time. Photographs are taken during the procedure so we can show you what has been found. A dissolving stitch is used in each incision and patients are usually able to go home later the same day.
The uterine cavity is assessed by introducing a small (5mm) telescope (hysteroscope) gently through the opening of the cervix into the uterine cavity. It is possible to see if there are any polyps, fibroids or congenital uterine septum inside the cavity and to see the openings of the fallopian tubes and whether they appear normal. It may be possible to surgically treat polyps and small fibroids identified during the procedure. See here for further information about operative laparoscopy and hysteroscopy.
A semen analysis may have been booked for you. It will be performed on the day of consultation and prior to seeing the doctor in order that the doctor can make an informed judgement about your future investigation or treatment. Types of Semen analysis carried out are :
- Semen analysis.
- Culture & sensitivity of the semen.
- Presence of anti-sperm antibodies in the semen.
If a sperm test has been performed in an assisted conception unit within the three months prior to your consultation and you are able to supply us with the result, there will be no need to repeat this test. If not, it is important that a semen analysis be carried out at the time of your consultation. Please abstain from intercourse for three days before your visit to us.
Should you wish this test to be performed prior in the days before the consultation or should you have any concerns, please telephone our reception and ask to discuss this with the laboratory.
