Fertility Assessment

What is a Fertility Assessment?

A fertility assessment involves a series of tests and evaluations to determine a person's ability to conceive and carry a pregnancy to term. The evaluation may include physical exams, blood tests, and imaging studies to assess the health of the reproductive organs and identify any potential fertility issues. It may also include an evaluation of the person's overall health and lifestyle factors affecting their fertility. The results of a fertility assessment are used to develop a treatment plan for infertility.


Infertility Evaluation

Infertility or subfertility is usually defined as the inability to conceive after 12 months of having unprotected sexual intercourse for a man or in a woman under 35 years of age or after six months in a woman over 35 years of age.


Infertility evaluation is used to help diagnose and treat any underlying issues that may prevent a couple from conceiving, such as hormonal imbalances, structural issues, or underlying medical conditions.


When to Seek Advice?

Studies have shown that while a large majority of couples (80-90%) usually conceive within the first year of attempted conception, the likelihood of conception decreases over time and with advancing age. The likelihood of conception is highest in the first three months of trying and then decreases. In women under 35, 4 in 5 couples should conceive within the first six months. Therefore, it is reasonable to seek fertility advice and investigations after six months of unsuccessful trying for conception.


A study has suggested that after six months of trying for conception, 1 in 2 of the remaining couples who fail to conceive may need fertility assistance. Therefore, in general, I would advise a discussion with your General Practitioner (GP) or a fertility specialist after 4 to 6 months of trying for conception, depending on your age and individual situation, to consider starting investigations.


What are the Benefits of Fertility Assessment?

Fertility assessment can help identify potential causes of infertility and guide the selection of appropriate treatment options. It can also provide a sense of how likely it is for a couple to conceive naturally or with medical assistance. Additionally, fertility assessment can provide information about the overall health of the reproductive system and can identify underlying medical conditions that may need to be addressed. Overall, it can help individuals and couples make informed decisions about their reproductive health and plan for their future.


What Does a Fertility Assessment Include?

Female Assessment

A female fertility assessment typically includes 

  • Medical History - consisting of questions about menstrual cycles, previous pregnancies, and any previous or current medical conditions or treatments that could affect fertility.
  • Physical Examination - a pelvic exam and ultrasound measurement of the ovaries and uterus.
  • Laboratory tests - may include 
  • blood tests to check hormone levels, such as follicle-stimulating hormone (FSH) and luteinising hormone (LH), and
  • check for the presence of certain infections.


Infertility Investigations

Infertility tests for women can also include:

  • Ovulation testing: involves tracking ovulation by measuring hormone levels or monitoring changes in cervical mucus or basal body temperature.
  • Hormone testing: Blood tests measure levels of hormones such as FSH, LH, estradiol, and progesterone, which are involved in ovulation and the menstrual cycle.
  • Imaging tests: Ultrasound scans can check the uterus and ovaries for abnormalities, such as polyps or cysts.)
  • Sonohysterogram and Hysterosalpingo-contrast Sonography (HyCoSy): A specialised ultrasound that looks at the uterus and fallopian tubes' shape and checks for blockages or other abnormalities. A thin tube is inserted into the uterus, and a special gel is used to visualise the uterus and fallopian tubes for any structural issues.
  • Laparoscopy: A surgical procedure that allows the doctor to see inside the abdomen and pelvis to check for problems such as endometriosis or blockages in the fallopian tubes.
  • Hysteroscopy: A procedure where a thin tube with a camera is inserted through the cervix to examine the inside of the uterus for problems such as fibroids or polyps.
  • Ovarian reserve testing: includes tests such as a blood test, Anti-Mullerian Hormone (AMH) and via an Antral follicle count (AFC) on ultrasound . These both assess the number of eggs in a woman's ovaries. There is no test for egg quality. 


For men, laboratory tests may include 

  • Semen analysis: to check the count, motility and structure of the sperm. This will usually require an ejaculated sample for assessment 
  • Sperm DNA fragmentation testing: helps to assess the quality of the sperm
  • Anti-sperm antibody testing: checks for immune cells that might be acting against the sperm
  • Second-line testing: Hormonal assessment, testicular ultrasound and genetic testing may be recommended to identify any underlying causes of sperm problems. 


Genetic Carrier Screening

This is a blood or saliva test that looks for faults in a person’s genes. It can help to provide information for couples about the chance of having a child with certain genetic conditions. Couples who are found to have a higher chance of having a child with a genetic condition will be given information about their reproductive choices. 


You can find further helpful information via the following links:


Fertility Preservation

Fertility preservation is the process of preserving your fertility for the future. Depending on your situation, this may involve freezing eggs, embryos or sperm for your future use. In certain circumstances ovarian tissue freezing or specific hormonal suppression (with a medication called Goserelin may be used as alternative methods for fertility preservation.  Fertility preservation may be elective or medically-indicated.


Egg Freezing

Egg freezing is an increasingly popular option for preserving fertility. This method involves stimulating the ovaries to produce multiple eggs, collecting the eggs via a day surgery procedure, followed by freezing  and storage of the mature eggs  for future use. Egg freezing can be a safe and effective way to preserve fertility and can be combined with other fertility preservation methods.


What Happens After a Fertility Assessment?

Once you’ve completed your fertility assessment, the next step is to discuss the results with your doctor. Dr Crawford can guide you on moving forward with the most appropriate fertility treatments for your situation. Depending on the results of the fertility assessment, your doctor may recommend lifestyle changes, medications, or other treatments to improve your chances of conceiving.


Who Can Perform a Fertility Assessment?

A fertility specialist, a gynaecologist, or other medical professionals can perform fertility assessments. Your doctor will be able to provide you with the most accurate information about your fertility status and will be able to determine the best course of action regarding your fertility.


What is the Cost of a Fertility Assessment?

The cost of a fertility assessment will vary depending on the type of assessment you need and the provider performing the examination. Generally, a basic fertility assessment will often cost between $500 and $1,000. Some of this may be covered by Medicare, depending on your situation. The cost may be higher if you need more comprehensive testing, such as bloodwork or imaging. You may also be eligible to apply for the NSW Government fertility testing rebate: https://www.service.nsw.gov.au/transaction/apply-for-the-pre-ivf-fertility-testing-rebate.

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