Problems Conceiving? When To Get Help

If you’re trying to get pregnant in your late thirties or forties and it’s not happening, how late should you wait? Dr Rosemary Leonard gives her personal view.

If you’re trying for your first baby together, get help after six months

Help from your gp

It’s helpful if you give your GP a menstrual diary and note of when you have sex. The problem can just be wrong timing – or trying too hard (that can lower the sperm count)

Your GP should offer a blood test, to be done during a period, which will check baseline hormone levels, including follicle – stimulating hormone (FSH), luteinizing hormone (LH) plus levels of prolactin and thyroid hormones, which also affect ovulation. A high FSH level, and a low anti-Mullerian hormone or AMH level can indicate the ovaries are running out of follicles, which a high LH level may indicate polycystic ovarian syndrome, which can lead to erratic ovulation and periods.

A check of whether ovulation has occurred can be done by testing progesterone levels seven days after the estimated date of ovulation. Home ovulation test are a useful starting point.

Some GPs may also be able to arrange an AMH level check, a measure of ovarian reserves. It’s worth asking for one if you’re in your late thirties, although NHS availability varies.

At least a third of infertility cases are due to a male factor so your partner should give a semen sample, done by appointment at hospital. This shows the number of normal and abnormal sperm and checks for infection. This can be treated with antibiotics or – if it’s a borderline result – by lifestyle changes such as stopping smoking and reducing alcohol intake.

If you’ve had heavy or painful periods, a pelvic ultrasound scan can rule out fibroids or ovarian cysts. But to detect blocked tubes, a dye test at a fertility clinic is needed.

Should you see a fertility expert?

The next step is to see a fertility expert, who will assess whether you may benefit from something like intrauterine insemination (IUI) before considering IVF. Whether you can be seen free of charge on the NHS varies according to rules set by your local Primary Care Trust (PCT) or GP commissioning board.

There are guidelines (available on nhs.uk) about IVF availability, such as an upper age limit of 39 and being infertile for at least three years, although many doctors would be prepared to take a lenient view on this for someone in their late thirties, who has been trying for say, two years. However, PCT’s have additional exclusion criteria, such as having no existing children from any previous relationship. In some areas, these rules are also applied to other treatments and even to referral to a fertility clinic. You should be able to find out the rules in your area from either your GP or your PCT website.

What about going private?

This breach of the HFEA's

The stringent NHS rules mean that, for many couples, paying for treatment is the only option. Price and the chances of success can vary enormously, but before you pay anything, talk to your GP about what treatment you’re likely to need, and your chances of success.

For example, treatment with drugs alone to stimulate ovulation is likely to be a lot cheaper than IVF. ICSI (intracytoplasmic sperm injection), used where the sperm count is low, is a specialised form of IVF where a single sperm is used to fertilise the egg, and is even more expensive.

Then do your homework by checking websites. Top of your list should be the HFEA (hfea.gov.uk), which licenses all fertility clinics, check their prices. You can often save money by taking results of tests already done by your GP, but don’t expect your GP to prescribe any medication – that has to come from the clinic, and can add considerably to your final bill.