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When you have a fertility problem, the first thing to do is go visit a specialist, who will try to determine the cause. You can be referred to a specialist by your GP or get a letter of referral to a private clinic. The doctors will run a series of tests to determine where the problem lies.

At the clinic, some basic tests will be performed. The tests for women include an ultrasound scan to check ovaries and womb; blood tests to check for levels of hormones involved in ovulation such as follicle-stimulating hormone (FSH), luteinising hormone (LH) and progesterone; and chlamydia and rubella tests, if they haven’t been done already.

Men will be tested for quantity and quality of sperm with a semen test. If there are no sperm or if the count is very low, the test should be repeated, usually within three months. Anyway, sperm’s quality and quantity varies with time, so that test will only be a guide throughout the process.

If these tests fail to find a specific reason for problems with conception, other tests can be offered to the female partner, like the following:

Hysterosalpingogram
What it involves: a dye is injected through the neck of the womb. As it fills the womb cavity and travels into the fallopian tubes, it is viewed by x-ray.
Used to: check if the fallopian tubes are blocked.

Hysterosalpingo-contrast sonography
What it involves: a vaginal ultrasound probe is used to enable the doctor to examine the womb and fallopian tubes.
Used to: check the fallopian tubes for blockages.

Laparoscopy
What it involves: the doctor makes a small incision near the navel and inserts a small telescope (a laparoscope) to allow him or her to inspect the womb and fallopian tubes. A dye can be injected through the cervix to see if it runs through the fallopian tubes (laparoscopy and dye).
Used to: check for scar tissue, endometriosis or blockage of the fallopian tubes. A laparoscopy is usually offered if you’ve had pelvic inflammatory disease, endometriosis or an ectopic pregnancy.

Hysteroscopy
What it involves: a small microscope, called a hysteroscope, with a camera attached is passed through the vagina and cervix to view the womb.
Used to: check for fibroids, polyps or any other abnormalities.

These are the usual tests run by specialists. They may vary and be confronted, being that a decision taken by the professionals. That is why it is always important to stick to a clinic and follow the suggestions made by the doctors.

Further development in In Vitro Fertilization (IVF) can increase pregnancy rates, according to a research article published by Dr Bruce Shapiro and DR. Said Daneshmand of the Fertility Center of Las Vegas, USA. The article, titled “Contrasting patterns in In Vitro Fertilization pregnancy rates among fresh autologous, fresh oocyte donor and cryopreserved cycles using day 5 or day 6 blastocysts may reflect differences in embryo-endometrium synchrony”, states that pregnancy rates in IVF cycles can be influenced by endometrial receptivity.

The research suggests that embryos that are slower to develop fail to implant because they are not in synchrony with the endometrium. The main belief, up to now, was that these embryos were less viable for fertilization, but the study shows that the main problem is lack of synchronization. Slower embryos tend to miss the endometrium´s  receptive phase because it is advanced by ovarian stimulation.

The main point this research was focused on was showing that the reduced rate for pregnancy with slow embryos only appeared in fresh non-donor cycles, in women that had just undergone ovarian stimulation. It disappeared in cycles where thawed embryos were used and in cycles of egg donation.

The study implies that pregnancy rates can be improved by waiting for a more receptive endometrium: that is, freezing the embryos and transferring them at a later stage of the cycle. An average rate of 33%, according to the researchers, can be improved to 59% through freezing.

This notion is controversial for most fertility specialists, because endometrial receptivity is not considered usually as a major factor in fertility problems. However, other experts in the area agreed to the fact that with appropriate synchronization, pregnancy rates of more than 70 % can be achieved.