Infertility is defined as not conceiving after 1 year of regular, unprotected sex, though evaluation may begin sooner depending on age or known risk factors. Diagnosis involves several steps, beginning with a GP visit and progressing to more advanced tests or referrals.
WHEN TO SEE YOUR GP
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Under 40: If you’ve been trying to conceive for 12 months without success.
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Over 36: Referral may be made after 6 months, as fertility naturally declines with age.
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Earlier referral may be advised if you or your partner has:
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A history of cancer treatment (e.g., chemotherapy or radiotherapy)
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Known reproductive health conditions such as endometriosis, PCOS, or testicular problems
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A history of sexually transmitted infections (STIs), pelvic inflammatory disease (PID), or surgery affecting reproductive organs
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INITIAL GP ASSESSMENT
Medical and sexual history (for both partners):
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Previous pregnancies, miscarriages, or terminations
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Menstrual cycle regularity and flow (for women)
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Contraceptive history
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Sexual frequency, timing, and difficulties (e.g., erectile dysfunction)
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Medical conditions such as diabetes, thyroid disorders, or autoimmune diseases
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Lifestyle factors (smoking, alcohol, drugs, diet, weight)
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Family history of reproductive issues
Physical examination:
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Women: BMI check, pelvic exam (fibroids, ovarian cysts, signs of endometriosis or PID)
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Men: Testicular and penile exam (undescended testes, varicocele, or structural issues)
DIAGNOSTIC TESTS FOR WOMEN
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Blood tests
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Progesterone test (day 21 of cycle): Confirms ovulation.
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FSH, LH, prolactin, thyroid hormones: Help assess ovarian reserve and hormone balance.
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Infection screening
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Example: Chlamydia test, as an untreated infection can cause blocked tubes.
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Ultrasound scan
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Examines ovaries, uterus, and fallopian tubes.
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Detects fibroids, ovarian cysts, and uterine abnormalities.
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Tubal patency tests
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Hysterosalpingo-contrast sonography (HyCoSy): Ultrasound with dye to check if fallopian tubes are open.
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Hysterosalpingogram (HSG): X-ray with dye to visualise blockages in the fallopian tubes.
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Laparoscopy (minor surgical procedure)
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Used if other tests suggest possible blocked tubes, endometriosis, or pelvic scarring.
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Provides a direct view of pelvic organs.
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DIAGNOSTIC TESTS FOR MEN
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Semen analysis (first-line test):
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Assesses sperm count, motility (movement), and morphology (shape).
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Identifies low sperm count (oligospermia), no sperm (azoospermia), or poor motility.
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Infection screening: For example, testing for chlamydia or other STIs.
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Hormone tests (if semen analysis is abnormal): FSH, LH, and testosterone to check for hormonal imbalances affecting sperm production.
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Testicular ultrasound: Recommended if physical abnormalities are suspected, such as a varicocele.
NEXT STEPS AFTER INITIAL TESTS
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If a clear cause is found (e.g., blocked tubes, low sperm count, anovulation), treatment may begin.
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If no obvious cause is found (unexplained infertility), the GP may refer you to a specialist fertility clinic for further evaluation and possible assisted reproductive treatments, such as:
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Ovulation induction medications
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Intrauterine insemination (IUI)
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In vitro fertilisation (IVF)
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Intracytoplasmic sperm injection (ICSI)
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WHY EARLY DIAGNOSIS MATTERS
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Age factor: Female fertility declines significantly after 35, making timely evaluation crucial.
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Male fertility: Although decline is slower, sperm quality also decreases with age.
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Treatable conditions: Many underlying causes (e.g., hormonal imbalance, infections, structural problems) can be effectively managed if diagnosed early.
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Emotional well-being: Early assessment helps reduce the stress and uncertainty couples face while trying to conceive.
In summary: Infertility diagnosis (refer to this blog by the NHS) begins with a GP consultation, followed by medical history, physical exams, and targeted tests for both partners. Depending on results, couples may receive treatment directly or be referred to fertility specialists for advanced care.
If you have been through this journey, Harley Street Fertility Centre is at your service. Our Fertility Specialists are available for consultation. Please follow this link to book an appointment.
