Fertility Assessment

Fertility Assessment


What Is a Fertility Assessment?

A fertility assessment is a structured medical evaluation designed to determine a person’s ability to conceive and carry a pregnancy safely. It involves:

  • Medical history: Menstrual cycles, previous pregnancies, miscarriages, contraception history, medical conditions, medications, and family history.
  • Lifestyle review: Weight, smoking, alcohol intake, exercise, stress levels, and occupational exposures.
  • Physical examination: Including pelvic examination and ultrasound assessment of the uterus and ovaries.
  • Laboratory tests: Hormone testing and screening for infections or underlying conditions.


The results guide personalised recommendations and treatment options.


Benefits of Fertility Assessment

A fertility assessment provides clarity, guidance, and reassurance for individuals and couples planning a pregnancy or experiencing infertility. The key benefits include:

  • Early Identification of Problems: Detects ovulation disorders, tubal blockages, uterine abnormalities, endometriosis, hormonal imbalances, and male factor infertility before they cause prolonged delays.
  • Understanding Ovarian Reserve: Provides information about egg quantity through AMH testing and antral follicle count, helping guide timing decisions and fertility preservation planning.
  • Assessment of Male Fertility: Evaluates sperm count, motility, and morphology via semen analysis, ensuring that both partners are appropriately evaluated.
  • Improved Natural Conception Rates: Identifies simple, treatable conditions such as thyroid imbalance, vitamin deficiencies, or irregular ovulation that can significantly increase the chance of pregnancy.
  • Personalised Treatment Planning: Allows tailored management options including lifestyle changes, ovulation induction, surgical correction, or assisted reproductive treatments.
  • Reduced Emotional Stress: Provides answers and clear next steps, replacing uncertainty with a structured plan.
  • Genetic Risk Identification: Enables carrier screening and informed reproductive choices by identifying inherited conditions.
  • Preparation for High-Risk Pregnancy: Optimises medical conditions before conception, improving safety for both mother and baby.
  • Evaluation of Recurrent Pregnancy Loss: Identifies underlying causes such as hormonal, genetic, or anatomical factors that may be treatable.
  • Support for Fertility Preservation: Guides decisions regarding the freezing of eggs, sperm, or embryos for future family planning.
  • Cost-Effective Long-Term Approach: Reduces unnecessary treatments and shortens time to appropriate care.
  • Improved Overall Reproductive Health: Assesses hormonal balance and gynaecological well-being beyond fertility.


A structured fertility assessment empowers individuals and couples to make informed, timely, and confident decisions about their reproductive future.


When to Seek Fertility Advice?

Infertility is usually defined as:

  • Under 35 years: No pregnancy after 12 months of regular unprotected intercourse.
  • 35 years or older: No pregnancy after 6 months of trying.


However, earlier assessment is recommended if there are irregular cycles, known endometriosis, polycystic ovarian syndrome (PCOS), previous pelvic surgery, recurrent miscarriage, or known male fertility issues.


Most couples conceive within the first 6–12 months. If pregnancy has not occurred within this timeframe, early investigations can reduce delays and improve success rates.


Pre-Conception Testing and Pregnancy Planning

Pre-conception care aims to optimise health before pregnancy.


What Pre-Conception Testing May Include:

  • Blood group and antibody screen: To detect Rhesus status.
  • Rubella and varicella immunity: Ensuring protection against infections that may affect pregnancy.
  • Thyroid function testing: As thyroid disorders can impact fertility and pregnancy outcomes.
  • Iron levels and vitamin D: To optimise nutritional health.
  • Diabetes screening: Particularly if there are risk factors.
  • Cervical screening update: Ensuring routine screening is up to date.


Folic acid supplementation is recommended at least one month before conception and during early pregnancy to reduce the risk of neural tube defects.


Lifestyle advice includes maintaining a healthy weight, limiting alcohol, stopping smoking, and reviewing medications for safety in pregnancy.


Genetic Carrier Screening

Genetic carrier screening is a simple blood test or mouth swab that assesses whether a person carries variants associated with inherited conditions.


Even healthy individuals with no family history can carry gene variants. When both partners carry the same genetic condition, there is an increased risk of having an affected child.


Medicare bulk bills screening for the 3 common genes:

  • Cystic fibrosis
  • Spinal muscular atrophy
  • Fragile X syndrome

Expanded panels may test for many additional conditions, often over 400 genetic conditions.


If both partners are carriers of the same condition, options may include:

  • IVF with preimplantation genetic testing
  • Use of donor sperm or eggs
  • Natural conception with prenatal testing
  • Adoption


Early screening provides informed reproductive choices.


Female Infertility

Female infertility may result from:

  • Ovulation disorders: Such as PCOS or thyroid dysfunction.
  • Tubal factors: Blocked or damaged fallopian tubes.
  • Uterine abnormalities: Fibroids, polyps, adhesions.
  • Endometriosis: Affecting egg quality or tubal function.
  • Age-related decline: Reduced egg number and quality over time.


Ovarian Reserve Testing

  • Anti-Müllerian Hormone (AMH): Blood test estimating egg quantity.
  • Antral Follicle Count (AFC): Ultrasound measurement of follicles.


There is currently no direct test for egg quality, which is closely related to age.


Male Infertility

Male factors contribute to approximately 40–50% of infertility cases.


Causes May Include:

  • Low sperm count
  • Poor sperm motility
  • Abnormal sperm shape
  • Hormonal imbalance
  • Genetic conditions
  • Varicocele (enlarged veins in the scrotum)
  • Lifestyle factors (smoking, obesity, heat exposure)


Understanding and Managing Male Infertility

A structured male fertility evaluation may include:

  • Semen analysis: Assessing count, movement, and morphology.
  • Hormonal blood tests: Including testosterone, FSH, LH, and prolactin.
  • Testicular ultrasound: To identify structural abnormalities.
  • Genetic testing: If severe sperm abnormalities are present.


Management may involve:

  • Lifestyle modification
  • Hormonal treatment
  • Surgical correction (e.g., varicocele repair)
  • Assisted reproductive techniques such as IVF or ICSI


How Is Infertility Tested?

Infertility testing is tailored to each individual but commonly includes:


For Women:

  • Ovulation tracking: Hormone blood tests or cycle monitoring.
  • Pelvic ultrasound: Assessing uterus and ovaries.
  • Tubal Ultrasound: Checking fallopian tube patency.
  • Hysteroscopy D&C: Direct visualisation of the uterine cavity.
  • Laparoscopy and dye studies: Evaluating endometriosis, pelvic adhesions, and to check tubes.


For Men:

  • Semen analysis: Primary screening test.


Investigations are usually minimally invasive and performed as outpatient procedures.


Fertility Preservation

Fertility preservation allows individuals to protect their future reproductive potential.


Options Include:

  • Egg freezing: For women wishing to delay pregnancy.
  • Embryo freezing: Fertilised eggs stored for future use.
  • Sperm freezing: For men before medical treatment.
  • Ovarian tissue freezing: In selected cases.


This is particularly important before cancer treatment or other medical therapies that may affect fertility.


High-Risk Pregnancy Care

Some pregnancies require additional monitoring.


High-risk factors include:

  • Advanced maternal age
  • Diabetes or hypertension
  • Multiple pregnancy
  • Previous pregnancy complications
  • Recurrent pregnancy loss
  • Genetic abnormalities


Management may involve:

  • More frequent ultrasounds
  • Specialist obstetric input
  • Fetal growth monitoring
  • Early intervention planning


Early identification improves maternal and fetal outcomes.


Recurrent Pregnancy Loss

Recurrent miscarriage is generally defined as two or more consecutive pregnancy losses.


Investigations may include:

  • Genetic testing of both partners
  • Uterine cavity assessment
  • Thyroid and hormonal evaluation
  • Autoimmune screening
  • Thrombophilia testing


Treatment depends on the underlying cause and may involve hormonal support, surgical correction, or medical therapy.


What Happens After a Fertility Assessment?

After completing investigations, the results are reviewed in detail. A personalised plan may include:

  • Timed intercourse guidance
  • Ovulation induction medication
  • Surgical treatment
  • Referral for IVF or assisted reproduction
  • Lifestyle optimisation


Clear communication and shared decision-making are central to successful care.


Cost and Support for Fertility Assessment

The cost of fertility assessment varies depending on the required testing. Medicare may cover part of the cost of consultations and investigations.


Early consultation reduces delays, identifies treatable causes, and supports informed reproductive choices.


What To Do Next?

If you are concerned about any of the symptoms above or are having difficulties with fertility, talk with your general practitioner.
This will help clarify what to do next and whether a referral to our practice is the next step.