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Question 1: Waiting period before seeking help

I know the recommended waiting period before seeing a specialist is 1 year if I am under 35. Yet a year feels so wasted if I do then get to a specialist only to learn I have needed ART all along. Have you ever wished patients would have gotten to you sooner than that? Are there any other criteria/ warning signs which would send a patient to you sooner?
If the year gets too long, is there a “basic” set of tests which can be done just to see if the year is worth waiting out?


Infertility is defined as the inability to conceive after one year of regular unprotected intercourse, with an estimated prevalence of around 15% in the general population. The chance of conceiving after one month of regular unprotected sex for a 20-year old woman is 25%, whereas it is 21% for a 30-year old and 8% for a 40 year old. There are 3 broad reasons why a couple may struggle to conceive:

  1. Anovulation – if a woman is not ovulating (releasing an egg) every month;
  2. Pelvic/tubal factor – if the fallopian tubes are damaged & the sperm is unable to reach the egg to fertilise it;
  3. Male factor – if the sperm are unable to fertilise the egg.

The basic tests to assess these factors are:

  1. D21 progesterone – a blood test to confirm whether you ovulate or not
  2. Hysterosalpingogram (HSG) or laparoscopy – to assess whether your fallopian tubes are patent
  3. Semen  analysis – to assess the quality of your partner’s sperm

Factors that may suggest an underlying condition and thus necessitate earlier work-up include:

Irregular periods – which is indicative of anovulation and is a key feature of polycystic ovary syndrome (PCOS). Some of the other symptoms of PCOS include acne and male-pattern hair growth. Painful periods or pain with intercourse – which may be due to a gynaecological condition, such as endometriosis, adenomyosis, fibroids or pelvic inflammatory disease (PID). A malodorous vaginal discharge, with pelvic pain and fever can be due to a sexually transmitted infection that may lead to tubal damage.  Prior pelvic surgery or a history of prior ectopic pregnancy suggests possible tubal damage. Being overweight – impacts on your reproductive system and hormonal imbalances can lead to a failure to ovulate.  For each unit of BMI (body mass index) – your weight divided by your height squared – above 30, women have a 4% reduction in fertility.

For men, illnesses like mumps can cause swelling of the testicles and lead to abnormal sperm. Injuries – even a minor sporting injury – that is associated with painful swelling of the testes, can be associated with testicular damage and warrant assessment. Painful urethral discharge is suggestive of a sexually transmitted infection.

The basic tests that can be arranged by your gynaecologist include a pelvic ultrasound, day 21 progesterone and semen analysis.

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