When Should You Seek Fertility Assessment?
NICE guidance recommends seeking assessment if you have been having regular unprotected sex (every 2–3 days) for:
- 12 months — if the female partner is under 35
- 6 months — if the female partner is 35 or over
However, you should seek earlier assessment — without waiting 12 months — if any of the following apply:
- Irregular or absent periods, suggesting you may not be ovulating regularly
- A known condition associated with reduced fertility, such as PCOS, endometriosis, or previous pelvic inflammatory disease
- A history of pelvic or abdominal surgery that may have affected the tubes
- A male partner with known concerns about semen quality
- Previous chemotherapy or radiotherapy
If you have any of these risk factors, waiting 12 months before seeking assessment is not recommended.
Initial Fertility Blood Tests — Female Partner
The standard initial blood tests for the female partner in a fertility investigation include:
- FSH (Follicle-Stimulating Hormone) and LH: Measured on days 2–5 of the cycle. Elevated FSH suggests reduced ovarian reserve. The FSH:LH ratio also gives information about ovulation.
- Oestradiol: Measured alongside FSH on day 2–5, to help interpret the FSH result.
- AMH (Anti-Müllerian Hormone): A marker of ovarian reserve — the best single measure of how many eggs remain. Can be measured at any point in the cycle. High AMH may indicate PCOS; low AMH indicates reduced reserve.
- Day 21 Progesterone: Measured approximately 7 days before the next expected period (not necessarily on day 21 if cycles are irregular). A level above 30 nmol/L confirms ovulation has occurred.
- Prolactin: Elevated prolactin can suppress ovulation and cause irregular periods.
- Thyroid function: Thyroid disorders are a common and treatable cause of ovulatory dysfunction.
- Rubella immunity: To ensure vaccination is up to date before pregnancy.
Initial Fertility Assessment — Male Partner
Male factor contributes to subfertility in approximately 40–50% of couples. Semen analysis is the first-line investigation — it assesses sperm count, motility (movement), and morphology (shape). This is straightforward, non-invasive, and can be arranged quickly. Results need to be interpreted carefully, with at least 2 samples tested if the first is abnormal.
Pelvic Ultrasound
A pelvic ultrasound assesses the ovaries (follicle count, appearance) and uterus (fibroids, polyps, shape). It cannot assess tubal patency (whether the Fallopian tubes are open) — that requires a separate procedure called a hysterosalpingogram (HSG) or HyCoSy, usually arranged by a fertility specialist.
How We Can Help
At Lambert Medical Practice, a private fertility assessment appointment allows us to take a full history, initiate all appropriate blood tests, arrange a pelvic ultrasound, advise on optimising natural conception, and where indicated, write a referral letter to a fertility specialist. Many patients arrive at a fertility clinic having already completed their initial investigations through us, saving significant time in the referral pathway.