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Fertility testing shouldn’t be scary – here’s everything you need to know

By Tess Cosad, CEO and co-founder at Béa Fertility

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Tess Cosad

For many experiencing problems conceiving, fertility testing can offer valuable health insights. Here Tess Cosad, CEO and co-founder at Béa Fertility, explains everything you need to know.

Around one in seven couples will have difficulties conceiving. Fertility problems can be caused by a number of factors, including health conditions like endometriosis and fibroids, having a low sperm or egg count, or lifestyle factors such as smoking.

For one in four couples, a specific cause cannot be identified. Nevertheless, the best place to start if you’ve been struggling to conceive for over a year is to undergo fertility testing.

What is fertility testing?

Fertility tests are investigations designed to help determine if there’s an underlying cause as to why you’re not getting pregnant.

You can undergo fertility testing via your GP, or you can order tests online using companies such as Hertility (female hormone and fertility testing) and ExSeed (sperm testing).

Based on the results of your tests, your GP should be able to advise on next steps to help you conceive.

There are different tests available to determine male factor infertility, female factor infertility or unexplained infertility.

What to expect when undergoing fertility testing?

The fertility testing process will differ slightly depending on whether you order tests online, or seek testing through your GP.

If you are going through your GP, they will usually ask questions about your menstrual cycle, your medical history, if you take any medications, how long you’ve been trying to conceive for and when and how often you have sex. These questions will help your doctor work out what investigations to perform.

Most commonly, these investigations will often involve blood tests to establish if you’re ovulating, an ultrasound to assess your uterus, fallopian tubes and ovaries and a semen analysis which will show the quantity and quality of semen and sperm.

It’s important to be honest and transparent when answering your GPs questions. Although the questions may feel personal, responding honestly will help them make well-informed decisions on best next steps.

What are the different types of fertility tests?

When you first approach your GP for fertility testing, they will perform some initial investigations using blood tests.

If you order a fertility testing kit online, you will usually be asked a series of questions to help the company determine which tests to send you.

The exact tests you undergo will depend on your specific circumstances, but will typically involve tests to assess menstrual cycle hormones, thyroid hormones and indicators of ovarian reserve.

  • AMH (anti-müllerian hormone) test – AMH is produced by the follicles in your ovaries, little sacs. Just as women’s egg count decreases with age, so do our AMH levels. An AMH test can give a good indication of egg quantity, and can also help signal some reproductive health conditions like polycystic ovaries.

  • P21 or progesterone test – This is a blood test that is performed in the middle of the luteal phase, which is after ovulation and before your period begins. The test is scheduled for seven days before your period begins, so the timing is based on the length of your cycle. In a 28 day cycle, this test would commonly be performed on day 21. The test measures progesterone levels to assess if ovulation has taken place.

  • FSH (follicle stimulating hormone) test – FSH stimulates the growth and production of eggs in the first part of the menstrual cycle. This blood test may be used to give an indication of the ovarian reserve – how many eggs you have in your ovaries.

  • LH (luteinising hormone) test – LH should reach a peak before ovulation: a rise in the hormone signals to the ovaries to release an egg. If LH levels are overly high, this can have an abnormal effect on the ovaries. The LH test is used to assess LH levels and their impact on egg release.

  • E2 (oestradiol) test – High levels of oestradiol may suppress other reproductive hormones that are responsible for ovulation, so an elevated E2 could mean that you’re not ovulating each month. The E2 test assesses E2 levels to understand whether this hormone is impacting ovulation.

Depending on your circumstances, your GP may also arrange the following tests:

  • Prolactin test – Elevated levels of prolactin may suppress ovulation, so prolactin may be checked if periods are absent.

  • TSH (thyroid stimulating hormone) – Both an overactive and an underactive thyroid gland can have an impact on ovulation. Measuring TSH levels would give an indication as to whether this is the cause of any fertility issues.

  • Testosterone – Raised levels of testosterone in women can disrupt the menstrual cycle and may lead to irregular cycles. In men, low levels of testosterone can impact sperm production.

An ultrasound may also be performed to examine the uterus, fallopian tubes and ovaries and identify abnormalities.

Testing for male factor infertility

During early fertility investigations, a semen analysis is often performed to check if there are any issues with the sperm, such as a low sperm count or low motility (movement of the sperm). They will test for the following factors:

  • Semen volume

  • Sperm concentration (concentration of sperm per millilitre of semen)

  • Sperm count (total number of sperm number)

  • Sperm motility

  • Sperm morphology (whether majority of sperm are ‘normal’ or abnormal forms)

If the result comes back abnormal, a semen analysis would usually be performed again in three months’ time.

The term infertility can sound scary, but it doesn’t mean you’ll never become a parent.

Fertility testing is the first step to help doctors identify the potential root of the problem, and they will use this information to recommend treatments and next steps.

Even if you are diagnosed with ‘unexplained infertility’, there are lots of brilliant fertility treatment options out there to help you on your journey to starting a family.

If you choose to seek fertility testing using a private company, rather than going through your GP, do your research to ensure you’re ordering your tests from a reputable source with a track record of accurate and actionable results.

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Fertility

Chelsea FC Women to launch first-of-its-kind player fertility fund

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Chelsea FC Women is to launch a fertility fund giving players access to assessments, treatments, counselling and workshops.

The initiative is part of a new partnership with London fertility clinic Fertility Plus, which has been named the club’s official fertility partner.

Chelsea said the fund will be available to every player in its women’s team, with support tailored to individual needs.

Giulia Mazzia, commercial director for Chelsea FC Women, said: “At Chelsea FC Women we are never done pushing for progress for our players and our community.

“This first-of-its-kind partnership with Fertility Plus will open up the conversation about fertility, help to raise awareness for our incredible fanbase and beyond, and give practical support to our players off the field as well as on it.”

Support through Fertility Plus will include fertility assessments and treatments, as well as counselling and workshops.

The partnership will also provide evidence-based information about reproductive health and address misconceptions around fertility.

Chelsea cited previous research on fertility knowledge which found that 41 per cent of respondents actively trying to conceive did not know when their fertile window was.

The club and Fertility Plus plan to provide educational content, resources comparing fertility myths with medical evidence and insights from Chelsea FC Women ambassadors.

Dr Amit Shah and Dr Anil Gudi, co-founders of Fertility Plus, said: “Elite sport asks a lot of women during the very years when fertility matters most, yet it’s a conversation the game has rarely had.

“Partnering with Chelsea FC Women allows us to help change that by giving players, staff and supporters access to trusted fertility expertise and compassionate, consultant-led care.

“We’re proud to work alongside a club that’s setting a new standard for supporting women’s health, both on and off the pitch.

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Fertility

Higher doses of common fertility drug may increase pregnancy risks

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Higher cumulative doses of common fertility drug clomiphene citrate may increase pregnancy loss risks, according to new research.

Around one in six people experience infertility, with irregular or absent ovulation among the most common causes.

Clomiphene citrate has long been a mainstay of fertility treatment, but Adelaide University research has raised concerns about higher cumulative doses.

The new study found that high doses of clomiphene citrate accumulated over multiple fertility treatment cycles could increase the risk of pregnancy loss.

Lead author associate professor Sheree Boulet said the findings showed a clear dose-response relationship, meaning the risks increased as cumulative exposure rose.

She said: “Women who received higher cumulative doses of clomiphene citrate experienced progressively greater risks of adverse pregnancy outcomes.

“We examined more than 21,000 embryo transfer cycles across four cumulative dose categories and found that increasing the dose did not significantly improve the chance of a live birth.

“Our findings suggest there may be a point where increasing the dose offers little additional benefit while exposing women to greater risk, highlighting the importance of carefully balancing effectiveness with safety when making treatment decisions.”

Supported by the NHMRC and conducted in partnership with Boston University and the Centers for Disease Control and Prevention, researchers analysed 21,004 IVF embryo transfer cycles in the US.

Women receiving cumulative doses of 500mg to 749mg of clomiphene citrate had a 12 per cent higher risk of miscarriage, while those receiving 750mg to 999mg had a 38 per cent higher risk.

Women receiving cumulative doses of 750mg or more were also more than twice as likely to have twins or other multiple births.

Rates of spontaneous abortion, another term for miscarriage, increased as the dose rose.

Researchers also recorded more than a threefold increase in stillbirth at the highest dose, although the finding was not statistically significant because that dose was rare. Larger studies are needed to confirm the association.

The finding is consistent with an earlier Adelaide University study that showed a doubling of neonatal death in pregnancies involving clomiphene citrate. Neonatal death means the death of a baby shortly after birth.

Higher cumulative doses did not improve the chance of a live birth, but did increase twinning, which raises the risk of adverse outcomes for both mother and child.

Clomiphene citrate is one of the world’s most widely prescribed fertility drugs. It has been prescribed to millions of women worldwide since 1967 and remains a recommended first-line treatment for ovulation induction.

The drug is recognised as an essential medicine by the World Health Organization. It works by stimulating the ovaries to release eggs, increasing the chance of pregnancy.

Women who do not respond to lower doses, or who require multiple treatment cycles, may receive progressively higher cumulative doses over time.

The findings build on a series of studies from Adelaide University’s Robinson Research Institute linking clomiphene citrate with increased risks of pregnancy loss, stillbirth, perinatal death and some birth defects.

Experimental studies in mice supported these findings, showing that higher doses reduced successful pregnancies and were associated with pregnancy loss, impaired fetal growth and developmental abnormalities.

Professor Michael Davies, senior researcher and co-author of all the studies, said the latest work builds on more than two decades of Adelaide-led research into the safety of fertility treatments.

He said: “Clomiphene citrate has been used by many women since 1967, but it has never been comprehensively evaluated in large prospective clinical trials.

“Our studies indicate that women respond differently to clomiphene citrate and that increasing cumulative doses may increase the risk of adverse pregnancy outcomes without improving the likelihood of a live birth.

“The findings confirm and extend our previous studies in both human and mouse models which highlight the need to better understand the dose-response relationship and whether more personalised dosing strategies could improve safety.

“Until we can better understand these differences, it remains important that clinicians rigorously follow manufacturer’s safety recommendations and avoid unnecessarily increasing cumulative doses.

“The same questions are now being asked of newer ovulation-inducing medications, so any move away from clomiphene citrate should also be guided by robust evidence rather than assumptions about safety.”

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Fertility

No clear evidence common embryo transfer techniques improve IVF success, review finds

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Common IVF preparation techniques used before embryo transfer have no proven effect on pregnancy rates, according to a review.

Researchers said evidence for the widely used practices remains uncertain because available studies are limited and generally of low quality.

Embryo transfer is the final and most vulnerable stage of IVF, when an embryo is placed into the womb. Only around one in three transfers results in pregnancy.

Practice varies between clinics, with some routinely using preparation techniques such as adjusting bladder fullness while others do not consider them necessary.

Dr Ryosuke Akino, practising obstetrician-gynaecologist from Kato Ladies Clinic, said: “To an extent, this is a case of tradition driving practice rather than the evidence.

“Current practices in this area often reflect local protocols, clinician preference, and historical convention rather than strong, high-quality evidence.”

The Cochrane review analysed 11 studies involving 2,524 women undergoing embryo transfer.

Researchers looked at three preparation techniques used by fertility clinics: having women arrive with a full bladder to straighten the angle between the uterus and cervix, removing cervical mucus and using a technique called afterloading.

Afterloading is a technique used to guide the embryo through the cervix.

The review found no reliable evidence that any of the three approaches improved pregnancy rates compared with standard care.

Researchers rated the evidence as low or very low certainty because the trials were small and had methodological weaknesses. They found no grounds to recommend any of the techniques over standard care.

There was also limited information about possible side effects.

The review team, which included methodologists and practising obstetrician-gynaecologists, said full bladder preparation and cervical mucus removal were generally considered safe, with no clear evidence of harm or major complications.

Dr James Brown, obstetrician-gynaecologist from Women’s Health and Research Institute Australia, said: “While these techniques are generally considered safe, it’s still important to test their effectiveness.”

Akino and Brown added: “A full bladder can be uncomfortable, although it may ease catheter insertion in certain uterine positions and reduce procedural difficulty.

“Mucus removal is usually quick, but if done roughly and causes bleeding, it may affect the woman’s experience.

“Overall, the risks are minor and relate mostly to discomfort and procedural factors rather than clinical harm.”

The authors said embryo transfer has changed relatively little despite major advances elsewhere in IVF.

Research has instead focused more heavily on embryo quality and genetic factors, which have a greater bearing on treatment success than transfer technique.

Embryo transfer also depends heavily on the person carrying out the procedure and can be difficult to standardise, making large, rigorous clinical trials harder to design.

Researchers said women may also be reluctant to risk valuable embryos by taking part in randomised studies comparing different transfer techniques.

Dr Noyuri Yamaji from Showa Medical University in Japan said: “Sixteen years of research still haven’t answered a basic IVF technique question.

“This is a critical step in the IVF process and these small changes and techniques have the possibility to make a massive difference, but we won’t know more until more robust, better-quality trials are conducted.”

All the studies assessed were carried out in high-income countries, meaning the findings may not necessarily apply to other healthcare settings and populations.

The authors said further research could be particularly valuable in resource-limited settings, where these procedures are inexpensive and simple to change and basic procedural standardisation could matter more than advanced technical modifications.

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