A routine fertility evaluation should include:
Assessing Female Age and Fertility
Many women hear frightening messages about how age reduces fertility and feel confused about when their fertility changes. A fertility evaluation can address the confusion by providing individualised assessment of egg reserve. Testing includes measuring Anti-Mullerian Hormone (AMH blood test) and the number of small follicles (antral follicle count on ultrasound) and in some women measurement of FSH hormone during a period. These tests provide a measurement of the timeline for natural fertility (assisting with family planning) as well as the expected outcomes of treatments such as IVF.
Assessing Tubal Patency
The most common test for tubal patency in our service is HyCoSy (an ultrasound test). The test is performed at the end of a period. A small catheter (soft tube) is passed through the cervix (neck of the womb) and a “dye” made of glucose/saline and air bubbles is gently injected into the womb. The dye appears white on ultrasound and can be seen passing through the tubes. The test can produce period-like discomfort. Women are advised to take pain relief when having this procedure.
Additional and Specialised Tests
Some couples require more detailed testing. All of the following are available in our service:
A small number of women require keyhole surgery (laparoscopy) to assess for conditions such as endometriosis. If surgical evaluation is required, Dr Anne will refer you to an experienced gynaecology surgeon.
Many couples complete a fertility evaluation and are told that no cause can be found for delayed conception. Unexplained infertility is defined as not conceiving over 12 months in the setting of regular ovulation, normal fallopian tubes, normal routine blood tests and a normal semen analysis. There are hundreds of events that have to proceed perfectly to achieve an ongoing pregnancy and routine testing cannot assess all of these events. Unexplained infertility is a difficult diagnosis however it is important to know that many couples with unexplained infertility (in particular, younger women) are still able to conceive naturally.
Bulk Billed Ovulation Tracking
Prior to ovulation, a 2cm “bubble” (follicle) can be seen in an ovary on ultrasound. Other features of ovulation include thickening of the “lining” of the uterus (endometrium) as well as high levels of oestrogen and LH hormones in the blood. Our service is able to provide monitoring of ovulation by ultrasound and blood tests to ensure the best timing for intercourse in the cycle. Ultrasound ovulation tracking is more accurate than temperature monitoring, phone Apps and other forms of home ovulation monitoring. Bulk billed ovulation tracking is beneficial in many circumstances:
Tubal patency is commonly assessed via tests such as HyCoSy and hysterosalpingogram. Flushing the tubes with oil based media ("poppy seed oil" or lipoidal) can be considered in some couples with infertility in particular in younger couples with an unexplained diagnosis or mild endometriosis. This procedure may improve the chance of natural conception in the months following the procedure.
Lifestyle changes can make significant improvements in the natural fertility of both women and men. This includes ceasing smoking, exercising more, improving nutrition and reducing alcohol. Obesity can increase the risk of infertility and miscarriage. Women with PCOS can improve ovulation and their chance of conceiving naturally after losing as little as 5% of their body weight if they are overweight or obese. Weight loss is difficult to achieve at any time in life, however it can be more challenging when managing the difficulties related to infertility. We can provide access to an experienced dietician to provide guidance and support for weight loss in preparation for conception and pregnancy.
Medical Ovulation Induction
Women with irregular cycles can find it difficult to conceive because:
Even when the cycles is “monthly” (a regular 28 day cycle), the chance of pregnancy is only 25% per month even in young couples. Tablets treatments are available to create a “monthly” cycle in women with conditions such as polycystic ovarian syndrome. These include Metformin, Letrozole and clomiphene.
Intrauterine insemination (IUI) is a simple procedure where prepared sperm (“washed” and concentrated) is injected into the uterus prior to ovulation. IUI cycles can be performed in:
IVF and Assisted Reproduction
Dr Anne works in partnership with Queensland Fertility Group and is able to provide assisted reproductive treatments including IVF, ISCI, preimplantation genetic diagnosis as well as donor conception options. A low cost pathway for IVF is available (conditions apply). See About IVF or visit Queensland Fertility Group for more information.
Pregnancy Loss: Recurrent Miscarriage | Ectopic Pregnancy | After Stillbirth
Couples who have experienced pregnancy loss walk a different road in pregnancy. In this setting, early pregnancy can produce fear and distress rather than the joyful feelings that many newly pregnant couples experience. Dr Anne provides a patient centred model of early pregnancy care in this setting. This means that women can develop a plan for early pregnancy monitoring in partnership with their doctor. Counselling with our fertility counsellor is also available.
Please see fact sheet “Recurrent miscarriage” for more information on testing and managing this condition.
Looking After Yourself When Trying to Conceive
Infertility can produce a significant life crisis. The experience of infertility impacts on self-esteem, relationships, sexual intimacy, friendships and can even extend into the workplace. Common experiences include anger, feelings of isolation and a sense that life is “on hold”. It is important that fertility care provides attention and support to this crisis. The team at QFG Cairns includes an experienced fertility counsellor. After hours education sessions are also available to people undergoing IVF focussing on relaxation techniques and self care.