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Female Checkup

fertility check-ups

Female fertility check-up

A female fertility check-up or assessment will help you understand your fertility status and your ability to conceive.

Increasingly we are seeing many women attending the clinic for a fertility check-up so that they can decide whether to delay having a baby until the time is right or consider freezing their eggs for the future (often if they are yet to find the right partner). For many women, it is also the first step in deciding whether to have treatment.

Whatever situation you are in, a fertility check-up at the Harley Street Fertility Clinic will provide you with the vital information you need to make informed decisions for your future, whatever you decide that to be.

What is checked?

We strongly believe in the value of talking to our patients and getting to know them before running tests on them. Hence, our female fertility check-up begins with a consultation, in which a fertility specialist will take a detailed medical history to discuss any existing medical conditions and explore any problems that could be relevant.

We will measure your height, weight, blood pressure and carbon monoxide (CO) level as all of these may impact your fertility.

A baseline pelvic ultrasound scan and blood test will be arranged between days 2 – 5 of a 28 day cycle. The ultrasound scan is an internal scan of the womb and ovaries. The scan will allow your specialist to assess your ovarian reserve by measuring your antral follicle count and volume of your ovaries.

If you have had relevant investigations performed elsewhere or you have had treatment elsewhere please bring those reports with you for your consultant to review.

Your consultant will then arrange for preliminary investigations to be performed in order to make a diagnosis and advise you of the best treatment options.

The specialist will also assess the health of your uterus and ovaries, including checking for any pathology such as ovarian cysts, uterine fibroids or polyps. The blood test will measure a panel of hormones: anti-mullerian hormone (AMH), follicle stimulating hormone (FSH), lutenising hormone (LH), oestradiol (E2), thyroid function (Free T4 and TSH), prolactin and vitamin D levels.

The results of your tests will be discussed with you at a follow up consultation. The specialist will advise you on your fertility status, as well as provide advice on any changes that may be required to your lifestyle to improve your health and maximise your fertility potential. If assistance is needed, they will also discuss treatment options to help you conceive or help you plan for the future.

Further investigations

The baseline scan and blood test provide a good picture of your fertility status but do not provide complete information. In certain cases, your specialist may advise you to have further investigations.

The most common investigations are:

A Midcycle scan

A further pelvic scan performed during the middle of your cycle (days 10 – 12 of a 28 day cycle) allows us to monitor follicular development towards ovulation and the thickness of your endometrium (the lining of your uterus).

3D Saline Infusion Scan

A 3D saline infusion scan (SIS), in which saline is used as a contrast agent, allows the specialist to examine the uterine cavity in greater detail for presence of any pathology, such as endometrial polyps, submucous fibroids and congenital uterine abnormalities. Such pathology might interfere with getting pregnant.

Tubal patency test

A Hysterosalpingo-Contrast Sonography (HyCoSy) is an ultrasound procedure used to assess the patency (open-ness) of the fallopian tubes and detect abnormalities of the uterus and endometrium. The procedure uses a non-toxic contrast agent for visualisation under ultrasound. The HyCoSy is a safe and reliable alternative to the conventional hytsterosalpingogram (HSG) that uses X-rays.

If you are considering trying naturally, timed sexual intercourse, ovulation induction or intra-uterine insemination (IUI), you will require patent fallopian tubes in order to achieve a pregnancy. Occluded (blocked) fallopian tubes are a common cause of infertility. Tubal occlusion can occur as a result of a number of conditions, including previous pelvic infection, previous appendicitis, pelvic adhesions and severe endometriosis. Many women will be unaware that these conditions are present or that tubal occlusion has occurred.

There is also some recent evidence to indicate that blocked fallopian tubes may reduce the chances of pregnancy in IVF.

The Triple-Test

Harley Street Fertility Clinic now offers all three of the above investigations, in a single combined appointment. Combined with the baseline scan and hormone profile, these results will provide you with a detailed picture of your fertility status.

When can the Triple-Test be performed?

Firstly, it is important that you are not pregnant when you have the Triple-Test, as the procedure can disturb the pregnancy. It is recommended that you avoid intercourse from the first day of your last menstrual period up to the day of the procedure to avoid pregnancy.

The best time to perform the procedure is during the middle of your cycle before you ovulate, approximately days 10 –12 of a 28-day cycle. If you have shorter cycles, you will need to have the test earlier. If your cycle is longer, but still regular, you may be able to have the test slightly later. If your periods are infrequent or irregular, please discuss the timing of the test with your specialist.

You will need to be screened for chlamydia and gonorrhoea before the procedure to exclude infection. Your consultant may also suggest you have a high vaginal swab for the same reason.

Is it painful?

A Triple-Test is considered a simple procedure lasting approximately 40 minutes and no anaesthetic is required. Most women experience mild to moderate discomfort similar to period cramping. If you are sensitive or have a low threshold for pain you can have some local anaesthetic to minimise the pain. This can be discussed with your consultant.

We advise that you take over the counter pain relief 30 minutes prior to the procedure. We recommend Ibuprofen (400 mg) and Buscopan (10 mg). If you are allergic to Ibuprofen another option is Paracetamol (1 gram).

A prophylactic course of antibiotic will be prescribed: 1gm of Azithromycin and 1gm Metronidazole tablets 1 to 2 hours before procedure.

You may eat and drink normally before the procedure.

How is a Triple-Test performed?

Initially, a normal pelvic scan is performed to measure the development of your follicle(s) and thickness of your endometrium. Then a small amount of saline is introduced into the uterine cavity, which allows ultrasound visualisation of the contour and shape of the cavity. The specialist will be looking for presence of uterine pathology detailed above. Next, a small amount of contrast dye will be introduced through the catheter. The injection of the contrast dye may cause some discomfort similar to the uterine cramps experienced during menstruation. The dye can be clearly visualised under ultrasound. The specialist will be looking to see if the dye freely flows through both fallopian tubes and spills out at the end of the tube into the area around the ovaries. If this occurs, the tubes are open.

What are the risks?

The Triple-Test is a safe and well tolerated procedure for the assessment of tubal patency. Infection of the uterus or pelvis is not common but can occur in rare cases. You should contact the clinic immediately if you have the following symptoms:

  • Persistent or foul-smelling vaginal discharge
  • Increasing lower abdominal pain
  • Unexplained fever
  • Extended general malaise

Such symptoms may indicate treatment with antibiotics. Please inform your consultant if you have a history of pelvic infection because they may prescribe you with antibiotics to prevent infection prior to the procedure.

After the procedure

You should wear a sanitary towel after the procedure because there may be persistent vaginal discharge for a few hours as the fluid used in the HyCoSy drains out of the vagina. This discharge is sometimes blood stained, so do not become alarmed if this occurs. You should be able to resume normal daily activities after the procedure.

Your consultant will discuss the results of the procedure with you directly after it has been performed.

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