The Béa Blog

Feel like you’re being directed to the most expensive wine bottle on the menu (*ahem, IVF*)? These 5 questions are for you. Be bold, be brave, and feel completely entitled to ask your fertility clinic in your first consultation.

Recently we’ve had a few questions surrounding lubricant. Whether it needs to be used with the Béa Treatment, what ingredients to look out for, and what the difference is between non-spermicidal and sperm-friendly lubricant. This article will explore all of this, a lubricant (lubricated?) deepdive, if you will. Let’s go. 

Are you thinking about taking the next steps on your fertility journey and considering IVF? We know it can seem overwhelming, intimidating and even a little scary - we’re here to help. You’re not alone, and you’re not wrong in feeling those things. There’s a reason we believe IVF should be the last step in your fertility treatment pathway – it’s invasive, it’s gruelling, and for so many people it can be both really exciting, and a bit sh*t when you’re going through it.  To help you feel more prepared for your first appointment, and for your IVF treatment in general, we asked Sandy - our Lead Fertility Coach and Embryologist, with over a decade of experience - to put together an article that will help you understand what to expect, what are the red and green flags to look out for when choosing a clinic, and what questions you may want to ask in your initial consultation. She’s really gone to town here, so we hope it helps.   In this article: Section 1: What can you expect in your first appointment? Section 2: What questions should you be asking in your first appointment? Section 3: IVF clinic green flags Section 4: IVF clinic red flags Section 5: Resources for more information What can you expect from your first appointment? During your first visit/initial consultation with a fertility specialist, they will review your medical history and any previous investigations or treatments you may have had. They may ask questions related to your menstrual cycle, reproductive health and sexual health. This could include if you have painful periods, if you experience pain during intercourse or if you’ve ever had a sexually transmitted infection. This will help them determine what investigations need to be performed to see if there’s an underlying cause of infertility/delay in getting pregnant. Here’s what you should do to prepare: bring results of any previous investigations make notes of any medications you or your partner are taking make a note of your/your partner’s last period and any symptoms experienced   What questions should you be asking in your first appointment?; We’ve really gone to town here to help you feel as prepared as possible: What additional investigations might I need before proceeding with treatment? What treatment option is the best for me and why?  What are your success rates for patients my/my partner’s age?  What could my chances of success be based on my age/fertility background (to help manage expectations)?  What can we do to prepare to increase our chances of success?  What additional support do you offer (nutritional, holistic, counselling)?  How long until you can start treatment/are there wait lists?  What time of day are appointments typically offered (to help balance work/life)?   Green flags 🤩 (great signs!) Free counselling. Going through any type of TTC journey can be strenuous, clinics that offer free counselling are at the top of our list. Friendly staff. Your experience in the clinic will be based on the outcome of your treatment, but also how you felt when going through treatment. Kind, caring and knowledgeable staff can make a huge impact. Transparent pricing. Treatments and treatment add-ons can get expensive. If the clinic provides a clear and detailed estimate, consider this a huge green flag. Good success rates. Success rates should be used as a rough guide and not a prediction, but if the clinic is consistent with the national average, and transparent about their success rates, this is a great start. Good patient rating. There are multiple ways to check this: the HFEA, Fertility Mapper and Google reviews are a good starting point.    Red flags 🚩 (things to watch for) Poor communication. Going through treatment requires a lot of communication with your clinic and care team. When this is lacking, it can make you feel anxious, cause unnecessary stress or concerns about the outcome of your treatment, which doesn’t help anyone get pregnant. Your care team dismisses your concerns. It’s easy to go down a Google rabbit hole and try to figure out what’s going on in your body. Your care team shouldn’t feel threatened by this, instead, they should act as a filter and a guide so you know what to trust and not trust online. Your care team feels distracted. IVF clinics can be busy but long delays or multiple interruptions during appointments can be a sign of issues with the number of staff and subsequently the quality of the care you’ll receive. No preparation before starting treatment. We’ve had customers tell us that clinics tell them to “Google IVF process” to prepare. Big red flag. Fertility care should be a collaboration between your clinic and you as a patient.   If you want more information than the clinic is giving you, where can you go? The UK charity Fertility Network UK. They have free resources and guides: https://fertilitynetworkuk.org/learn-about-fertility/treatment/ The HFEA (human fertilisation and embryology authority). They’re the regulatory body in the UK and gather data from clinics for publications (think pregnancy rates and trends) and also offer support resources: https://www.hfea.gov.uk/  Béa. We may offer a home insemination treatment, but we’ve also created guides and free resources for a range of different fertility conditions or treatment types to support all family forming ways: https://beafertility.com/blogs/fertility-library/in-vitro-fertilisation-ivf   Understanding IVF treatment add-on options When going through IVF, you may be offered a treatment add-on to improve your chances of having a baby. Treatment add-ons are supplementary treatments that can be performed during your IVF cycle. For most patients, having a routine cycle of fertility treatment is effective without using any treatment add-ons. As treatment add-ons come at an additional cost, you are not only a patient, but you also become a consumer paying for parts of your treatment. This can be really difficult to navigate, so we’ve put together this guide to help you.  Which treatment add-ons are available? Assisted hatching Assisted hatching is a laboratory process where embryologists use a laser, chemicals or a needle to create a hole in the zona, the outer layer of the embryo. Assisted hatching is meant to encourage the process of implantation in the uterus. This may be offered if there’s an indication of the embryos having thick zonas, or in cases where multiple embryo transfers have taken place without implantation. It is safe to perform on the embryos.  The HFEA says: "We cannot rate the effectiveness of this add-on at improving the treatment outcome as there is insufficient moderate/high quality evidence." Elective freeze all An elective freeze all cycle is a cycle of IVF where an embryo transfer does not take place; instead, all good quality embryos are frozen and an embryo transfer is planned for a different cycle. The procedure is safe. The HFEA says: "On balance, it is not clear whether this add-on is effective at improving the treatment outcome." Endometrial receptivity assay (ERA) ERA is a test that is meant to find the optimal time for an embryo to be transferred into a woman’s uterus for the embryo to implant, known as the window of implantation. ERA involves taking a biopsy of the endometrial lining of the uterus and testing the tissue to determine the optimal window to hopefully improve the chances of a successful implantation.  The HFEA says: "There are potential safety concerns and/or, on balance, findings from moderate/high quality evidence shows that this add-on may reduce treatment effectiveness." Endometrial scratch Endometrial scratching is a procedure performed by your doctor where the lining of the uterus is scratched using a small sterile plastic tube. The theory is that this procedure triggers the body to repair the site of the scratch, making the womb lining more receptive to an embryo implanting. There is a small risk of infection as it is an invasive procedure, but it is otherwise considered safe.  The HFEA says: "On balance, it is not clear whether this add-on is effective at improving the treatment outcome." EmbryoGlue EmbryoGlue is a hyaluronate enriched medium that is used at the time of embryo transfer. It contains hyaluronan, a component which is usually present during implantation, and the theory is that the enriched medium promotes implantation, to improve chances of having a baby. EmbryoGlue is a safe treatment. The HFEA says: "On balance, it is not clear whether this add-on is effective at improving the treatment outcome." Immunological tests and treatments One theory widely shared for unexplained infertility is that the cause may be the patient’s immune system. A range of tests and treatments may be offered, but the treatments involved could have a serious impact on the patient’s immune system. Because there is no evidence that any immune cells ever do prevent a pregnancy, there is no reason for any patient without an immunological disease to take these therapies. The HFEA says: "There are potential safety concerns and/or, on balance, findings from moderate/high quality evidence shows that this add-on may reduce treatment effectiveness." Intracytoplasmic morphologic sperm injection (IMSI) IMSI is a sperm selection method used in ICSI. The technique involves using a microscope to view sperm under very high magnification, over x6000, compared to standard ICSI which uses x200 and x400. This is a safe add-on that allows embryologists to view detailed images of sperm. Scientific reviews suggest that IMSI could be beneficial in specific situations such as previously failed ICSI attempts. The HFEA says: "We cannot rate the effectiveness of this add-on at improving the treatment outcome as there is insufficient moderate/high quality evidence." Intrauterine culture Intrauterine culture uses a device that allows the patient to carry their embryos in the uterus for several hours during early development before the embryos can be transferred or frozen. The theory is that the embryos will develop better in a more natural environment as opposed to an incubator in the laboratory. There are no known risks to the treatment.  The HFEA says: "We cannot rate the effectiveness of this add-on at improving the treatment outcome as there is insufficient moderate/high quality evidence." Physiological intracytoplasmic sperm injection (PICSI) PICSI is a technique used to select sperm to use for ICSI treatment. It involves placing sperm with hyaluronic acid (HA), a natural compound found in the body. PICSI identifies sperm that can bind to HA and these sperm are selected to be injected. It is a non-invasive test used on sperm prior to ICSI and considered to be safe.  The HFEA says:  "On balance, the findings from moderate/high quality evidence shows that this add-on has no effect on the treatment outcome." Pre-implantation genetic testing for aneuploidy (PGT-A) PGT-A involves checking embryos for abnormalities in the number of chromosomes. Embryos with an abnormal number of chromosomes have less chance of developing into a baby and carry an increased risk of miscarriage. PGT-A identifies embryos that are unsuitable for fertility treatment. Embryologists perform a biopsy on the embryos to remove cells that can be tested for any chromosomal abnormalities. In some cases, the cells may not yield a result, or have a mix of both normal and abnormal chromosomes. There is a small risk that the biopsy can cause damage to the embryo, but it is otherwise considered safe. Some studies show that it can reduce the risk of miscarriage in older patients.  The HFEA says: "There are potential safety concerns and/or, on balance, findings from moderate/high quality evidence shows that this add-on may reduce treatment effectiveness" for improving chances of having a baby.  The HFEA also says: "On balance, findings from high quality evidence shows this add-on is effective at improving the treatment outcome" for reducing the chances of miscarriage. Time-lapse imaging  Time-lapse imaging is available through an incubator with a built-in camera that takes thousands of images of embryos while they’re growing. It allows for uninterrupted culture and it gives a continuous view of each embryo as it develops, rather than just viewing them once a day. Time-lapse incubation and imaging is safe and does not carry any additional risks to the embryos in culture or children born from them. The HFEA says: "On balance, the findings from moderate/high quality evidence shows that this add-on has no effect on the treatment outcome." Artificial egg activation Artificial egg activation is a laboratory process where embryologists use a chemical called calcium ionophore in order to attempt to improve fertilisation rates. This method may be offered if there has been a previous cycle where fertilisation has failed with ICSI. There’s not enough information to show if the procedure carries a risk of abnormal embryo development. The HFEA have removed artificial egg activation as it should only be used in specific circumstances. 

Here at Béa HQ, we've been talking a lot about transparency and trust recently. We know both play a major part in the decision-making process around fertility treatments, alongside reviews and hearing from voices other than ours (we're obviously a bit biased). That's why, we decided to include Net Promoter Scores (NPS), as a measurement of the experience we can offer you. Stick with us, this is going to get much spicier than you think. 🌶   So, NPS it is ✔️    What actually is NPS? Essentially, when someone uses the product, how likely are they to recommend it to others? You can recommend something enthusiastically (called ‘promoters’🙌), lukewarmly (called ‘passives’👍), or with a negative recommendation, i.e., “don’t use this” (called ‘detractors’👎).    Your NPS = % promoters – % detractors   Easy stuff. Our first port of call – go find a reference NPS so we know how we’re comparing. Ideally, you want your NPS to be around 80 (that’s really good, the highest it can be is 100).    So off we went to find the average NPS of fertility clinics. And what we found blew my mind. Thanks for sticking with me...😏   Fertility clinics NPS is -21.3. Yep, negative twenty one. For reference, the average NPS in healthcare is +34 (and that’s quite low). So fertility clinics are a full 55 points lower than the standard in healthcare. Errr… wtf? 🤯   How did we end up with an industry that is growing insanely quickly – and making record profits whilst at it – with a customer experience that is so bad it’s less than 0? Why is the clinical fertility experience so bad? What can we do to make it better? And if we’re going into an IVF or IUI treatment, what can we do to protect ourselves and advocate for our own experience? We have more questions than answers at this point, we're afraid we're still reeling from -21.3… But we will be back with answers on how to make sure you get the best out of your clinical experience. 

Does cooling one's balls really improve sperm quality? Is it time to reclaim and redefine the term ‘blue balls’ in fertility? The short answer is…maybe. We've taken a deep dive into how temperature affects sperm quality, so you don't have to.

Acupuncture for fertility is the only complementary therapy recognised by the HFEA, and evidence suggests it can be helpful in supporting fertility journeys. We spoke to Lora from Circe Health to find out more about this ancient therapy. 

Let's dive right in shall we? Family planning – it doesn't matter if you want to have one child or three it's important to know when you need to start trying. Of course, everyone is different. There are lots of factors at play.

Freezing your eggs is seen by many as an insurance policy – allowing people to delay having children while they focus on different aspects of their life. Some are unsure if it’s right for them as egg freezing is expensive, invasive and does not guarantee a future pregnancy. Here we’ll explore what egg freezing involves, how much it can cost and what risks are involved.  What is egg freezing? Egg freezing is a method of fertility preservation, where eggs are collected and stored in order to try and have a family in the future. Frozen eggs can be thawed and used in fertility treatments at a later time.  When is egg freezing suitable? Egg freezing can be a suitable treatment option for both medical and non-medical reasons. You could consider egg freezing if: you have a medical condition or need treatment that may affect your future fertility (such as chemotherapy or are starting a long-term medication which can negatively affect fertility)   you are worried about your fertility or you are not ready to have children yet (also known as elective or social egg freezing) you are undergoing fertility treatment and do not wish to fertilise all of your eggs for ethical or religious reasons you are undergoing gender transition from a female to a male How is egg freezing performed? The step-by-step process: 1. Go to a fertility clinic for a set of fertility tests This is likely to include an AMH test, an internal ultrasound scan to assess your ovarian reserve and a blood test. 2. Have a consultation with a doctor Your fertility specialist will review the results of your investigations and help create a plan for treatment. You will also be required to sign consents for your treatment. This is an important step, as the consents are there to protect you and your eggs, and they will indicate how long you want your eggs to be stored. You will have a lot of paperwork from the clinic and be sure to ask your doctor or nurse if there is anything that doesn’t make sense.  3. Hormone stimulation The hormone stimulation stage of the egg freezing process involves daily injections of medication called gonadotropins. These drugs encourage your ovaries to produce multiple eggs. The stimulation process lasts for roughly 2 weeks. 4. Monitoring During the stimulation, you will attend the clinic for ultrasound monitoring every 2–3 days to ensure that your ovaries are responding well to the medication. It’s possible to have blood tests during this time as well. The dosage of the medication is subject to change based on how your ovaries are responding. Once the follicles in your ovaries have reached an appropriate size, you’ll be given a trigger injection (the final injection to help the eggs mature) and your egg collection will be scheduled.  5. Egg collection The egg collection generally takes place under sedation and you will need to fast in advance of the procedure if this is the case. Your clinic will inform you of when to stop eating, what medications to take and when to arrive at the clinic. The eggs are collected from the follicles in your ovaries using a long needle and transvaginal ultrasound scan. The fluid from the follicles is collected in test tubes that are passed to the embryologist in the laboratory, who will find the eggs under a microscope. The final number of eggs is confirmed once all follicles have been emptied and all test tubes have been checked. 6. Egg freezing You will receive an update from the laboratory on how many eggs are mature and have been successfully frozen. It is recommended to take the day off from work and give yourself some recovery time. Your nurse should let you know what medication to take for pain relief if you need it.  What are the costs of egg freezing? The average cost of an egg freezing cycle in the UK is around £3,350. This will often include the cost of the consultation and investigations, but it can vary from clinic to clinic, so be sure to get an estimate from your clinic. The medication for the hormone stimulation and the annual storage fee are often additional costs. When freezing eggs, you might not be thinking of the cost of using them in the future, but we’ve included it in this table: Average cost of egg freezing in the UK Egg collection and freezing (1 cycle) £3,350 Hormone stimulation medication £500–£1,500 Egg storage (per year) £125–£350 Thawing, fertilisation and transfer £2,500 Total cost of 1 cycle of egg freezing, 5-year storage and thawing £6,975–£9,100   Are there any risks involved? Risks with egg freezing include side effects from the hormone stimulation medication, like headaches, nausea, hot flushes, mood swings and ovarian hyperstimulation syndrome (OHSS). There is also a risk that the treatment might not work when using your frozen eggs and a pregnancy can not be guaranteed. Your fertility specialist will work with you to determine the number of eggs to freeze and should convey any additional risks to you.  How successful is egg freezing? Egg freezing treatments are increasing in number, however, the utilisation rate is still low. The utilisation rate refers to the number of people that are ready to have treatment with their own frozen eggs. One recent study has shown that only 6% of women have returned to have treatment with their frozen eggs. Success rates will highly depend on your age and the number of eggs you freeze. For patients aged 35 years or younger, about 15 mature eggs are needed for an anticipated 85% chance of future live birth, with more eggs required as patients age. You should discuss the number of eggs you should be aiming to freeze and the likelihood of success with your fertility specialist.  Additional information Two recent studies showed that most people that had frozen their eggs went on to conceive naturally. However, despite not needing them, the vast majority of people (91%) reported having no regrets over their decision to freeze their eggs and nearly everyone (98%) said they would recommend the process to a friend.  References: HFEA – Egg freezing 

Problems with ovulation are among the most common causes of fertility issues in females. If an egg is not released from the ovary, then it can’t get fertilised in order to make a baby. While it may be concerning if you’re not ovulating regularly, there is a treatment available that could help encourage ovulation in order to get pregnant through intercourse. Here we’ll explore the treatment called ovulation induction and how it works.  What is ovulation induction? Ovulation induction is a medical treatment that helps encourage ovulation if you’re not ovulating regularly. Reasons for not ovulating might be due to stress, PCOS, thyroid hormone imbalance or irregular menstrual cycles. The two main types of ovulation induction are:  Oral medication Medications like Clomid, tamoxifen or letrozole act by increasing the production of FSH (follicle stimulating hormone) which stimulates follicle growth and ovulation.   Daily injections of gonadotropins Drugs like Menopur or Gonal F contain FSH which stimulates follicle growth.  You might require ultrasound scans to monitor the response in your ovaries and will be informed of when to have intercourse for the best chances of conceiving.  What are the risks of ovulation induction? Response to the treatment is very individual and sometimes cycles may be cancelled if the response is insufficient or too strong. If you respond well to the treatment, your doctor may recommend continuing treatment for up to six consecutive cycles.  Some medications can cause undesirable side effects like bloating, nausea, headaches and hot flushes. Always consult with your doctor if you have any concerns regarding the medication.  References: NHS – Treatment for infertility  NHS - Ovulation induction 

Sperm DNA fragmentation refers to damage in the genetic material (DNA) of the sperm. Here we’ll explore what it is, how it’s measured and how it can be treated.  What is sperm DNA fragmentation? Sperm DNA fragmentation is when the DNA within the head of the sperm is damaged (fragmented). The damage is not known to have an impact on the fertilisation of eggs, however, high levels of sperm DNA fragmentation may negatively affect embryo development, implantation and pregnancy.  What are the causes of sperm DNA fragmentation? Sperm DNA fragmentation can occur during sperm production, sperm maturation or from external factors like oxidative stress (a condition caused by low levels of antioxidants). This in turn can be caused by inflammation or infections in the male genitals (like sexually transmitted diseases), varicoceles (enlarged blood vessels in the testicle), environmental and lifestyle factors, smoking and recreational drug use.  How do you test for sperm DNA fragmentation? Testing for sperm DNA fragmentation is a non-invasive procedure performed as an additional diagnostic tool and is not included in the standard semen analysis. There are no risks involved in testing as it uses a small sample of sperm that would not be used for treatment. Several different methods are available for assessing sperm DNA fragmentation and the results should be discussed with your clinician in order to understand if they are within normal range.  When might the test be offered? Sperm DNA fragmentation may be offered in cases of unexplained infertility or recurrent miscarriages. It may also be offered following a fertility treatment if there has been poor fertilisation, poor embryo development or after multiple cycles of IVF if you have not fallen pregnant.  How can you treat sperm DNA fragmentation? Changes to lifestyle is one of the most fundamental and simple ways to improve sperm quality and DNA damage. Men with low semen quality and high DNA fragmentation are recommended to quit smoking, reduce alcohol consumption, exercise and manage their weight. If an infection is present, it should be treated with a course of antibiotics and if varicoceles are the cause, then these can be surgically repaired. A common treatment that may be offered is an oral antioxidant therapy, however, currently, there is little evidence to support if oral antioxidants can repair DNA damage or increase the chances of having a baby.  References: HFEA – Sperm DNA damage WHO – Laboratory manual NICE guidelines – Trying for a baby 

An AMH test measures the levels of anti-müllerian hormone in the blood and helps assess the ovarian reserve. It’s often performed in fertility clinics to help assess how your ovaries may respond to a hormone stimulation. Here we’ll explore what AMH is, how to test for it and what limitations it has.  What is AMH? Females are born with all of the eggs they’ll ever have – roughly 1–2 million. By the time they’ve finished puberty, most people lose roughly 1,000 eggs each month (only one egg is ovulated, but more are lost in the process). AMH is a hormone produced inside the follicles of your ovaries that contain your eggs. As the number of eggs you have declines with age, so will the levels of AMH in your blood. Doctors use AMH levels to estimate how many potential eggs are left – this is known as the ovarian reserve.  How do you test your AMH levels? In a fertility clinic:  If you attend a fertility clinic for an assessment it will normally include an AMH blood test, an ultrasound scan to count the number of follicles in your ovaries and a consultation with a fertility specialist. The results of your tests will be discussed in the consultation along with your medical history and lifestyle. The specialist will discuss your fertility status and advise if there are any changes you could be making to your lifestyle to improve your overall health and your fertility.   At home: There are a few companies that offer home testing of AMH levels, and you can order online and receive your test kit within a few days. A blood sample is collected through a finger prick test and you post your kit to a testing laboratory. Results are often provided within a few days and can include a report, but they don’t always include a consultation with a medical professional.  What do the results mean? Your AMH results would be presented as a number, but there would also be an indication if they’re in a low, normal or high range.  Low level: A low level of AMH typically means that there aren’t many eggs left in your ovaries. This could also mean that the ovaries may not respond well to a hormone stimulation for egg freezing or in vitro fertilisation (IVF). But it doesn’t mean you can’t get or will have difficulty getting pregnant. Normal level: A normal level of AMH means that your result is within the reference range for females in your age group. High level: If your blood shows a very high level of AMH it could be an indicator of polycystic ovarian syndrome (PCOS). It could also mean a potential high response to hormone stimulation for fertility treatment and lower doses may be advised to reduce the risk of any severe side effects.   Limitations of AMH testing While AMH is widely used to give an indication of ovarian reserve and predict the response of a hormone stimulation for fertility treatments, it doesn’t give any indication of egg quality or predict your chances of getting pregnant. There is, however, a correlation between AMH levels and the likelihood of a successful IVF treatment cycle. Your chances of conceiving are also influenced by many factors including your age, lifestyle and health. AMH results can also be affected by outside factors such as taking hormonal contraception, how the sample is taken, the time between blood sample and analysis and how the sample is analysed. Therefore, it is important you consider using a service provider or laboratory you know to be reliable. AMH can vary slightly month to month, but does not tend to fluctuate markedly and generally follows a downward trend over time. References: NHS – IVF  The Doctors Laboratory - AMH 

Male fertility plays a part in nearly half of all infertility cases and can affect approximately 7% of all men. A semen analysis is one of the tests that should be offered to help determine if there is an underlying cause of difficulties conceiving. Here we’ll explain why you may have an analysis performed and what the results could mean.  What is semen? Semen is the thick cloudy, white fluid that comes from a man’s penis when they ejaculate. It contains seminal fluid which carries sperm cells out of a man’s body so they can fertilise an egg in order to create a pregnancy.  What is a semen analysis?  A semen analysis is a test performed to evaluate semen and sperm. The semen is collected by masturbation into a sterile pot, usually within a fertility clinic setting. The test will analyse the volume, how many sperm there are (concentration), how the sperm are moving (motility) and how they are shaped (morphology).   Why have a semen analysis? If you and your partner are having trouble getting pregnant, one of the first tests your doctor will likely ask for is a semen analysis. The aim of the test is to identify if semen is a factor affecting your fertility. It can also help determine what treatment type (if any) may be most suitable.  What do the results mean?  The World Health Organization has guidance on how to interpret semen analysis, which your doctor may refer to. The results are often presented in a report and should include: Volume - Volumes between 1.5 and 5 mL would be considered normal.  Concentration - Concentration is the number of sperm in one mL of semen. 15 million sperm per mL or more is considered normal. Total sperm count - The total sperm count is the total number of sperm found in the entire ejaculate. 39 million sperm or more would be considered normal. Motility - Motility measures the percentage of sperm that are moving. 40% or more moving sperm in the sample would be considered normal. Morphology - Morphology refers to how the sperm look based on the shape of the head, the midpiece and the tail. 4% or more normal forms is considered normal.  If the results are within the reference range, you may be encouraged to continue trying to conceive through intercourse for a total of 2 years before any treatment is offered. If the results show low sperm quality, you may be referred for additional tests or a repeat semen analysis, as results can vary between ejaculates. You may be referred for fertility treatment funded by the NHS after you have been trying for a total of 1–2 years. How to access a semen analysis Your GP should refer you for a semen analysis if you’ve been trying to conceive for 1 year. You may be referred earlier if there’s a reason to think the sperm count may be low. Alternatively, you could pay for a private semen analysis or a home sperm test. Additional resources We know that fertility investigations and treatment can be a challenging experience for men. A 2017 survey from the Fertility Network UK found that most respondents felt it affected their mental wellbeing, self-esteem and relationships. Visit HIMfertility https://fertilitynetworkuk.org/himfertility/ for more information and support.  References: NHS – Causes of infertility NHS – Low sperm count  NICE guidelines – Semen analysis  WHO - Laboratory manual 

We know it can be upsetting when you’re trying for a baby and you’re not getting pregnant as quickly as you may have hoped. The NHS explains that around 84% of heterosexual couples will conceive within a year if they have regular, unprotected intercourse. This means that some couples may conceive quickly, but for others, it may take longer. Here we’ll explain when you should seek medical advice, what you can expect from your GP and what your next steps may be.  When should you see a GP about your fertility? The National Institute for Health and Care Excellence guidelines state you should visit your GP if: You’re under the age of 35 and you’ve been trying to conceive for 1 year You’re over the age of 35. Get in touch with your GP sooner as you may be able to access investigations earlier You or your partner have a condition that is known to affect fertility, as you may be able to access investigations earlier What will you discuss with your GP? Your GP will perform an assessment and determine if you’re eligible to access tests in order to see if there are any underlying causes of the fertility problems you may be experiencing. They will ask specific questions relating to your reproductive health and sexual intercourse. This may feel uncomfortable to talk about, but it’s important to be as open as you can, as your GP is there to help you. In order to help you prepare for that visit with your GP, here are some questions you may be asked: Contraception If you’ve taken any type of contraception, your GP will want to know what type and when you stopped using it. They may ask if you experienced any side effects while taking/coming off of contraception. Your menstrual period You may be asked when your last menstrual period was, how long your menstrual cycles are and if they are regular. This can help determine if there’s any irregularity in your ovulation. Sexual intercourse You’re more likely to get pregnant around the time of ovulation, so your GP may ask you questions about when and how frequently you have intercourse. Known medical conditions or medication Some long-term medical conditions and some medications can have an impact on your ability to conceive. It’s important to discuss these with your GP to get the best medical advice when moving forward. Lifestyle factors Smoking and passive smoking can reduce the chances of getting pregnant. You may be asked about your alcohol consumption, as excessive drinking can have a negative impact on semen quality. You may be asked about your weight or asked to be weighed, as the guidelines recommend having a BMI between 19 and 30. Cervical smear Your GP will also make sure that your cervical smear is in date. Cervical screening is a way of checking if there are any abnormal cells in the cervix, which would sometimes need to be removed. This would need to be done before any potential pregnancy. Rubella status Your rubella status will also be checked, as you may need to have a vaccination before getting pregnant. Once the assessment has been completed, your GP may request investigations to determine if there’s an underlying cause of fertility problems. This will involve blood tests, an ultrasound and a semen analysis. For more information, read our article Common fertility tests. Treatment availability on the NHS Once your GP has completed your fertility investigations, they will decide if you need medical support when trying to conceive and if you are eligible for treatment funded by the NHS. You could be eligible for six cycles of IUI (intrauterine insemination) or three cycles of IVF (in vitro fertilisation) funded by the NHS. However, the provision of funded treatment is determined by your local area, so it’s important that your GP prepares you for what is available to you. Eligibility In order to be referred for treatment, you may have to fulfil certain criteria, which may include limitations based on your: Age Body Mass Index (BMI) Length of time trying to conceive Previous children Lifestyle factors Sterilisation  References: NICE – Trying for a baby  NHS – Treatment for infertility 

If you’ve been trying to conceive for over a year, it might be a good idea to make an appointment with your GP for some investigations. The tests may help determine if there’s an underlying cause of why you’re not getting pregnant. Here we’ll explore the different types of tests you may encounter.  What do GPs test for? Your GP will ask you about your menstrual cycle, your medical history, if you take any medications, how long you’ve been trying to conceive and may ask specific questions about the timing of when you have sex. Most commonly, investigations will involve blood tests, an ultrasound and a semen analysis.  Blood tests: P21 - This test measures progesterone levels to assess if ovulation has taken place.  FSH (follicle stimulating hormone) - This is used to give an indication of ovarian activity.  LH (luteinising hormone) - LH should reach a peak before ovulation, but elevated LH levels can have an abnormal effect on the ovaries.  E2 (oestradiol) - High levels of E2 may suppress other reproductive hormones that are responsible for ovulation, so an elevated E2 could mean that you’re not ovulating each month. In some cases, your GP may request additional tests like: Prolactin - 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, and measuring TSH levels would give an indication if this is the cause of any fertility issues. Testosterone -Raised levels of testosterone can disrupt your menstrual cycle and may lead to irregular cycles.  Ultrasound In addition to blood tests, you may also have a pelvic or transvaginal ultrasound examination to assess your uterus, fallopian tubes and ovaries. This is used to look for signs that your fallopian tubes could be blocked, which could be preventing the eggs from travelling down after ovulation or preventing sperm from reaching the egg. It could also determine if you have any conditions affecting your uterus, like fibroids or endometriosis, as they may have an impact on your chances of conceiving.  Semen analysis A semen analysis is performed to check if there are any issues with the sperm, such as a low count or low motility. The results will include: Volume  Sperm concentration (how many there are) Motility (how they move) Morphology (how they look)  Based on the results of your tests, your GP should be able to advise you on your next steps, in order to help you when trying to conceive.   References: NICE guidelines – Fertility problems  NHS – Diagnosis of infertility  

Most people want to know how long it will take them to get pregnant. Although we do know how long it takes on average for a person or couple, it is impossible to tell how long it will take you to get pregnant, because each person is unique. In this article, we discuss the average time to conceive and when you should consider speaking with your doctor about fertility. How long does it take to conceive? Most couples (around 8 in 10) will get pregnant within one year if they have regular, unprotected sex. For some, it can happen quickly, but we know it gets harder to cope with the longer it takes. Does age affect fertility? Yes, it does. This can be frustrating and upsetting because your age is not something you can control. Many people wait to have children later in life with good reason, like wanting to create a safe and supportive environment, focusing on their career first or trying to find the right partner to have a child with. The impact that age has on fertility can be due to the number and quality of eggs decreasing over time or the quality of sperm reducing with age. How to improve your fertility Fertility can also be affected by your lifestyle and there are some things you can do to improve it. These include: Quitting smoking Exercising Eating a healthy, balanced diet Managing any long-term conditions (like diabetes) Limiting alcohol Avoiding recreational drugs  How often should we be having sex? NICE (National Institute for Health and Care Excellence) guidelines advise to have sex every 2 to 3 days throughout the month to increase your chances of conception. However, we understand that this can be impractical or undesirable – having a set schedule for sex can make it feel like a chore. Some couples time sex by when the woman ovulates (releases an egg). Taking an ovulation test every day can feel burdensome and this can become tiring over time. It’s important to choose which method works best for you and your partner. You might decide to alternate between methods.  When should I get help with conception? Your GP should usually be your first port of call if you’re concerned about fertility. The guidelines in most areas suggest couples should be trying to conceive for at least a year before being investigated for fertility. However, there are situations when you shouldn’t wait to see your GP. These include: If you are over 36 If you have a known issue that could affect your fertility (like endometriosis, PCOS or low sperm count)  If you are concerned you or your partner may have an undiagnosed medical issue that may be affecting your ability to get pregnant References: NHS – How long does it usually take to get pregnant?  NICE guidelines – Trying for a baby Tommy’s – How long does it take to get pregnant? 

Talking to a GP about fertility can be difficult. However – your GP is there to help and support you. Here we discuss how to get the most out of your consultation. How to talk to your GP It can be worrying when you’re not sure what is going on with your body, but you should never feel embarrassed when talking about fertility with your GP. The more details you share, the easier it can be for them to help you. We’ve provided some tips that may make it easier: Understand if your period is irregular An irregular period is a cycle shorter than 21 days or longer than 35 days, having fewer than 8 cycles per year or having a cycle longer than 90 days. Having a regular cycle is a good indicator that you are ovulating.  Track your period Your GP will likely ask questions about your menstrual cycle, and it might help if you have details about how long your cycles are and how long your period normally lasts.  Don’t wait to get help If you’re trying to conceive and have a condition that impacts your fertility, like irregular periods, PCOS or endometriosis, you should visit your GP, as you may be able to access tests or treatments sooner.  Understand what care the NHS can provide NHS trusts across England and Wales are working to provide the same levels of service. But the provision of fertility treatment varies across the country, and often depends on local ICB (Integrated Care Board) policies. If you’re not sure, ask your GP to advise you.  You should visit your GP if: You’re under 36 years old and have been trying to conceive for 1 year You’ve over 36 years old and have been trying for 6 months If you have a known medical reason for fertility problems If you are a single woman or in a same-sex female relationship Your GP might carry out an assessment and perform some initial tests to see if there is an underlying cause of the delay in getting pregnant. They may determine if you’re suitable for clinical treatment in a fertility clinic. Read our article What alternative treatment options do I have? for more information.  Prepare for your appointment GP appointments can be short, so you may want to prepare in advance. You could write down details of: How long you’ve been trying to conceive The length of your menstrual cycle How long your period lasts Any symptoms you’ve been experiencing (such as painful periods or bleeding in between periods) Any specific questions you want your GP to answer (don’t be afraid to ask questions – there are no ‘silly‘ questions and it is better to share these with your GP so they have the chance to respond). Ask for another appointment if needed Appointments with your GP can feel too short. If this is the case, book a follow-up straight after. It is important you leave your appointments feeling more confident and understanding your next steps. We hope this helps you to make a start on getting the support you need.

Navigating fertility can be confusing. And the terms used when we talk about fertility can be equally so. To help you, we’ve put together this list of the most common terms.     Artificial insemination A procedure that involves directly inserting sperm into a woman’s uterus or cervix to help her conceive. Assisted reproduction Treatments that enable people to conceive without having sexual intercourse. Methods include intrauterine insemination (IUI), in vitro fertilisation (IVF), intracytoplasmic sperm injection (ICSI), donor insemination, egg donation and surrogacy. BBT Basal body temperature. A method used for tracking ovulation.  Cervix The lower part of the uterus that forms a canal between the uterus and the vagina. Egg or ovum The female reproductive cell. A woman usually ovulates one egg in a monthly cycle. Embryo A fertilised egg. ET Embryo transfer. A process where an embryo is transferred with a catheter from a culture dish in the laboratory, to the uterus.   Endometriosis A condition where the endometrium, the tissue that lines the inside of the uterus, is found outside the uterus. Fallopian tubes The pair of tubes leading from a woman’s ovaries to her uterus. The fallopian tube is where fertilisation of the egg by a sperm takes place. Follicle A small sac in the ovary in which the egg develops. FMU Foetal Medicine Unit’s specialise in supporting pregnancies where there may be a concern for the health of the unborn baby.  FSH FSH (follicle stimulating hormone) is a type of gonadotropin. It’s a hormone that a woman can take to stimulate her ovaries to produce eggs.  Gamete Reproductive cell (egg or sperm). Gonadotropin Gonadotropins are hormones that regulate ovarian and testicular function. hCG hCG (human chorionic gonadotropin) is a hormone that is produced during pregnancy. Pregnancy tests measure levels of hCG in blood or urine.    HSG HSG (hysterosalpingogram) is an x-ray procedure to confirm if the fallopian tubes are open and to view the inside of the uterus.  HyCoSy Hysterosalpingo Contrast Sonography is a scan that uses contrast dye to view the patency of the fallopian tubes.  ICI ICI (intracervical insemination) is a procedure in which sperm is placed near a woman’s cervix to help her conceive. ICSI ICSI (intracytoplasmic sperm injection) is a procedure where sperm are injected individually into eggs under a microscope.  IUI IUI (intrauterine insemination) is a procedure in which sperm are placed inside the uterus to help conceive.  IVF IVF (in vitro fertilisation) is a treatment where eggs are removed from the ovaries and fertilised with sperm outside the body. The fertilised egg, an embryo, is transferred to the uterus in order to create a pregnancy.  IVI IVI (intravaginal insemination) is a process in which sperm are inserted into the vagina.  LH LH (luteinising hormone) is a gonadotropin. During the menstrual cycle, LH levels will rise and trigger ovulation.  Medicated cycle A medicated cycle refers to a fertility treatment that is performed with hormone medication to stimulate your ovaries to produce eggs.  Menstrual cycle The menstrual cycle means the time between the first day of your period up until the day before your next period. The average length is around 28 days, but anything between 21 days and 35 days is considered ‘normal’. Natural cycle A natural cycle refers to a fertility treatment taking place during your menstrual cycle without any hormone medication.  OHSS OHSS (ovarian hyperstimulation syndrome) is a condition that can develop due to excessive response of the ovaries to stimulation drugs.  OPK OPK (ovulation predictor kit) measures the levels of LH in your urine to help predict when ovulation will happen.  Ovaries The female reproductive organs that produce eggs and oestrogen on a monthly basis. Ovulation The release of the egg from a follicle in the ovary. PCOS PCOS (polycystic ovarian syndrome) is a common condition that affects how a woman’s ovaries work and disrupts the hormonal balance in the body.  Period A period is the part of the menstrual cycle when the uterus sheds its lining and bleeds from the vagina for a few days. Sperm The male reproductive cell, which fertilises a woman’s egg. Uterus The uterus is a female reproductive organ in the pelvis that sheds its lining monthly (during menstruation) and is where a pregnancy is created and a baby grows.The uterus is a female reproductive organ in the pelvis that sheds its lining monthly (during menstruation) and is where a pregnancy is created and a baby grows.

This is a controversial question. Anti-müllerian hormone (AMH) is linked to female fertility, so AMH testing has its uses, but it’s not a crystal ball (if only!). Whether you’ve come across AMH before or you’ve never heard of it, you’ll want the facts.

You don’t need us to tell you there’s no equation for your future fertility. That said, there are choices you can make now that might pay off later down the line.

Freezing your eggs is seen by many as an insurance policy – allowing people to delay having children, while they focus on different aspects of their life. Some are unsure if it’s right for them as egg freezing is expensive and invasive.

You probably learned in sex-ed how to use contraception to prevent a pregnancy (makes sense, you were underage). Unfortunately, there’s no sex-ed for adults who want to get pregnant.