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Get off to a good start

If you’d like to make sure you have the best chance of fulfilling your dream of becoming a parent, make an appointment to speak with a City Fertility specialist.
At your first consultation, your specialist will take a thorough medical history from you and your partner (if applicable) and perform any relevant examinations. The specialist will use this information to provide you with the best options to maximise your chance of conceiving a baby.Your specialist will want to discuss things such as your menstrual cycle, how long you have been trying to conceive, lifestyle factors, and whether you have had any previous fertility treatment. Both partners (if applicable) are encouraged to attend this appointment.

Investigations

If you have had investigations ordered by your GP, it is important to make it known to your specialist before the first consultation so that these can be accessed. Most of these do not need to be repeated. Some tests are ordered to ensure you are ready for pregnancy, while others assess the specific cause of your fertility problem.

These tests may include:

Female fertility tests

• Common blood tests include follicular phase (early cycle) sex hormones (estrogen, luteinising hormone (LH), follicle stimulating hormone (FSH) and thyroid stimulating hormone).
• There is another blood test which predicts ovarian reserve, called the anti-Mullerian hormone (AMH), which is often done with an antral follicle count (AFC), via an ultrasound scan. AMH is a hormone produced by ovarian follicles that contain eggs. The level of AMH gives an indication of the ovarian activity in a month, or the number of eggs being produced (ovarian reserve).
• A pelvic ultrasound scan is performed to check the pelvic anatomy and exclude ovarian cysts. A hysterosalpingogram (HSG) is an X-ray dye study that will check the uterine cavity and exclude blockage of the fallopian tubes. This can also be done with a saline sonohysterogram, which is a specialised type of ultrasound scan.

Male fertility tests

• A “sperm count” is also known as a seminal fluid (semen) assessment. It looks at sperm concentration, motility (ability to swim), and morphology (shape). This test is generally referred to as a semen assessment.
• An abnormal blood count may require blood tests such as FSH, LH and testosterone.
• Depending on your history and the results of the initial tests, your treating doctor may request a sperm DNA fragmentation test or a testicular biopsy. For more information about these tests, please visit our page on Sperm test and semenassesment.

When to seek advice

At City Fertility, we recommend you seek medical advice from your GP or a specialist if you have not conceived after 12 months of trying, or after six months of trying if you are over the age of 35.
There are also other instances where you might want to seek earlier fertility advice. These include: early menopause; polycystic ovaries; irregular or non-existent menstruation; history of endometriosis; when either you are or your partner is a current or past cancer patient; or when the male partner has had a vasectomy. You and your partner will require a referral from your GP to see one of City Fertility’s specialists.Our friendly, caring staff share the same goal – to maximise your chance of conceiving a baby.

Sperm test

Male-factor infertility accounts for 30 per cent of infertility cases and is a common problem among couples trying to conceive.To determine whether a man has a reproductive problem that is causing infertility, a specialist can run different tests to reach a diagnosis.
Usually, doctors request a basic physical exam and a semen assessment, and often a blood test, to assess levels of hormones such as follicle-stimulating hormone (FSH), luteinising hormone (LH) and testosterone. Depending on the results, the specialist may require more checks, such as sperm DNA fragmentation, an immunobead test or a testicular biopsy. This section gives you detailed explanations of these male-specific tests.Please remember anyone can be affected by infertility and while it can be a challenging experience, the good news is that there are options available to help you achieve your dream of having a baby.

Male fertility tests

A semen assessment evaluates the amount and quality of a man’s semen and sperm to determine his potential fertility. This test is sometimes called a sperm count.
A semen assessment is used to assess the following:
• Motility: movement of the sperm (swimming ability).
• Morphology: percentage of sperm that have a normal shape.
• Count: the number of individual sperm present in one ejaculation.
• Vitality: the sperm’s ability to live and endure.

Why is it done?

A semen assessment can help clarify whether a man has a reproductive problem that is, in part, causing infertility, and then determine what treatment options are reasonable. A severely low sperm count or low motility may indicate the need for an advanced approach, whereas a normal semen assessment might suggest a more conservative strategy.

How is it done?

A semen sample is usually collected by masturbation, directing the fluid into a sterile container. No lubricants should be used as they might kill the sperm. Two to five days of abstinence are recommended before a semen assessment, to ensure the reliability of the test. Longer periods of abstinence may affect the accuracy of the results (less active sperm).
Once the semen sample has been collected, it should be delivered to the lab within one hour and kept close to body temperature.

What is sperm DNA fragmentation?

Sperm DNA Fragmentation is a test that provides a reliable analysis of sperm DNA integrity and may help to identify men who are at risk of failing to initiate a healthy, ongoing pregnancy. Information about sperm DNA integrity may help in the clinical diagnosis, management and treatment of male infertility.

Why is it done?

The genetic integrity of the sperm is essential for normal embryo development. A high level of DNA fragmentation in sperm cells may represent a cause of male infertility that a conventional semen assessment (sperm concentration, motility analysis or morphology assessment) will not detect.
Results reported in scientific literature have shown that regardless of the assisted reproductive technology (ART) used, an elevated level of sperm DNA fragmentation will significantly compromise the possibility of a successful pregnancy.

How is it done?

The sperm are captured within an inert agarose gel. These are treated with an acid denaturant, which removes already fragmented DNA. The remaining material is then treated with a lysing agent, which frees the intact DNA into the agarose gel. This gel is then stained to highlight the released DNA and evaluated to determine the degree of fragmented versus intact DNA.
Depending on what caused the damage to the sperm DNA, there may be a way to improve it. Some options are to change to a healthier lifestyle, quit smoking, avoid exposure to toxins, and take a daily supplement of antioxidants and zinc. Further clinical options can be discussed with one of our specialists.

What is a testicular biopsy?

A testicular biopsy, also known as Testicular Sperm Aspiration (TESA), is a test in which sperm is extracted directly from the testicles for analysis.

Why is it done?

A testicular biopsy is performed when the male partner does not have sperm in his seminal fluid. This could be due to a number of factors, including a vasectomy, failed vasectomy reversal, obstruction, retrograde ejaculation, abnormal anatomy (such as an absence of the vas deferens) or certain genetic defects.

How is it done?

Sperm are produced within a network of tiny tubes called “seminiferous tubules” inside the testicles. In the TESA procedure, a fine needle is passed into the testicles under anaesthetic, and a tiny amount of tubules is removed. These tubules are then processed in the laboratory and checked for the presence of sperm, which, provided they are viable, can either be used to fertilise eggs or frozen for use in the future with Intracytoplasmic Sperm Injection (ICSI) – a specialised form of In Vitro Fertilisation (IVF).

Sperm retrieved from the seminiferous tubules in a testicular biopsy procedure are much less in numbers, less mature and less motile than those found in ejaculated seminal fluid. As such, IVF with ICSI is necessary to achieve fertilisation with TESA sperm.