Younger than 35
After 12 months
If pregnancy has not happened and there is no reason to investigate sooner.
Thinking about pregnancy
Fertility & planning
You may be preparing for pregnancy, wondering about your fertility, or finding that conceiving is taking longer than expected. Start with the questions that matter to you.
You can ask for advice before there is a problem. A conversation can help you decide what to do now and when assessment would be useful.
01 / Before pregnancy
A preconception visit is a useful starting point.
Before you start trying, we can review your health, medicines, previous pregnancies, vaccinations and family history. We agree which tests are useful, discuss folic acid and address issues that are easier to manage before pregnancy.
This visit is about preparation. You do not need to have a fertility problem to book, and a blanket panel of fertility tests is not part of every visit.
02 / Trying to conceive
Keep the basics manageable.
If you are trying through vaginal sex, having sex every two to three days is a practical approach. Ovulation does not happen on day 14 in every cycle, and an app's predicted fertile window is an estimate.
Record the first day of your periods and whether cycles are regular. Ovulation kits can help some people, but tracking should not become a condition you have to meet before seeking care. Mention pain with sex, difficulty having intercourse or concerns about ejaculation.
If you need donor sperm, are planning pregnancy on your own or with a same-sex partner, or want to discuss preserving fertility, seek advice at the outset. The usual waiting periods for conception through intercourse do not describe every situation.
See NHS: trying to get pregnant. Our cycle and contraception guide explains cycle changes and contraceptive choices.
03 / When to ask for help
Age and history guide timing.
For someone trying to conceive through regular unprotected intercourse, these are common starting points for an assessment. You can discuss concerns earlier.
Age 35–40
After 6 months
Arrange an assessment earlier in the process.
Older than 40
Seek advice promptly
An early discussion helps avoid unnecessary delay.
Timing is based on ASRM guidance on fertility evaluation; individual circumstances can change the plan.
04 / Understanding the whole picture
Assess the couple. Choose tests with a purpose.
When a couple is trying to conceive, fertility assessment looks at both partners from the outset. A contributing factor may involve either partner or both; sometimes the initial tests do not identify a cause. This is a shared investigation, without blame.
Both histories matter.
We review periods, pregnancies, operations, infections and medicines, alongside the sperm-producing partner's health, previous fertility and any erection or ejaculation difficulties. A previous pregnancy or child does not rule out a current problem.
Investigate in parallel.
Semen testing should happen early, alongside the assessment of ovulation, the uterus and tubes. We bring the findings together before choosing treatment. If possible, attend together; each person can also discuss sensitive concerns privately.
For people planning alone, using donor sperm or conceiving with a same-sex partner, we adapt the assessment to who will provide the eggs or sperm and who will carry the pregnancy.
Approach: AUA/ASRM: assessment of the male partner and NHS: fertility investigations.
What might we investigate?
There is no automatic package that everyone needs. History, examination and earlier results help us start with useful, less invasive tests. Open each topic to see what it can answer.
Blood hormones: ovulation and possible causes of irregular cycles
Regular cycles often provide enough evidence of ovulation. If blood tests are needed, the question and timing matter:
- Progesterone can help confirm recent ovulation. It is usually measured about a week before the expected next period, rather than automatically on day 21. A single result does not measure egg quality.
- FSH and oestradiol, sometimes LH: selected tests can help assess absent or irregular periods. When used for ovarian reserve, FSH and oestradiol are usually checked together early in the cycle.
- TSH checks thyroid function when relevant. Prolactin may be useful with infrequent or absent periods or unexpected breast-milk discharge; it is not needed for everyone.
- Androgens, such as testosterone, may help investigate irregular cycles with excess hair growth or other signs of androgen excess.
- AMH helps with ovarian-response planning and can usually be measured on any cycle day. Read its limitations in the AMH explanation below.
Semen analysis: assess sperm early in the process
A laboratory checks the amount of semen, sperm concentration and total number, movement (motility), and shape (morphology). Follow the laboratory's instructions about abstinence, collection and delivery, and mention any incomplete collection or recent illness.
Results vary between samples. An abnormal result commonly needs repeating; one result is not a verdict on whether pregnancy is possible. Significant abnormalities may lead to an examination by a male-fertility specialist and selected hormone or genetic tests.
Further reading: AUA/ASRM: semen assessment and interpretation.
Pelvic ultrasound and saline scans: examine the uterus and ovaries
A pelvic ultrasound, often vaginal, assesses the uterine lining, fibroids, ovarian cysts and visible follicles. We discuss consent and alternatives if an internal scan is difficult. A normal routine scan does not prove that the tubes are open or exclude all endometriosis.
A saline-infusion scan introduces a little sterile fluid into the uterine cavity during ultrasound. It can define a suspected polyp, fibroid projecting into the cavity or scar tissue more clearly.
Further reading: ASRM: ultrasound and the uterine cavity.
HSG and contrast ultrasound: are the fallopian tubes open?
HSG (hysterosalpingogram) uses X-rays while contrast fluid passes through a small catheter in the cervix. It outlines the cavity and shows whether fluid passes along the tubes and spills out of their ends. It is usually arranged after a period and before ovulation, with pregnancy excluded.
Cramping and light spotting can occur; infection and contrast reactions are less common risks. Tell us about previous pelvic infection or contrast reactions. A suggested blockage may need confirmation because spasm can sometimes mimic obstruction.
HyCoSy is a contrast-ultrasound alternative that assesses passage through the tubes without X-rays. The choice depends on the clinical question and local availability. An open tube is reassuring about passage, but does not prove normal tube function or guarantee pregnancy.
Further reading: ASRM: HSG and NHS: contrast ultrasound.
Hysteroscopy: look inside the uterine cavity
A thin camera passes through the vagina and cervix into the uterus, without an abdominal incision. It can clarify a cavity abnormality seen on imaging, such as a polyp, a fibroid projecting into the cavity or adhesions. Sampling or treatment may be possible with prior consent.
It is selected when the findings could change care, rather than being a routine test for everyone. We discuss the setting, pain relief or anaesthesia, and risks such as bleeding, infection and rare uterine injury before proceeding.
Further reading: RCOG: hysteroscopy.
Diagnostic laparoscopy and dye: look around the pelvis
This is keyhole surgery under general anaesthesia. A camera through a small abdominal incision examines the outside of the uterus, tubes, ovaries and surrounding pelvis. Dye passed through the cervix can check tubal passage.
It may help when symptoms or earlier tests suggest endometriosis, adhesions or tubal disease. We agree beforehand whether treatment may be performed at the same operation. It is not a routine first test for unexplained infertility: possible benefit must justify surgery and its anaesthetic, bleeding, infection and organ-injury risks.
Further reading: ASRM: laparoscopy and hysteroscopy.
05 / Understanding ovarian reserve
You may have come across AMH.
If you have read about fertility or already started a fertility journey, you may have seen an AMH result discussed as an “egg count”. It helps to understand what we are actually measuring.
01 / Inside the ovary
Small follicles, growing within the ovary.
A follicle houses an egg. On ultrasound, we count the small fluid-filled follicles that have become visible, rather than the microscopic eggs themselves.
An illustrative selection, not every follicle in an ovary or a normal-count target.
Enlarge ovary illustration (new tab)02 / A closer look
One antral follicle, enlarged.
- 1The egg sits within a supporting group of cells.
- 2Granulosa cells surround the egg and line the follicle. In small growing follicles, these cells produce AMH.
- 3The antrum is the fluid-filled space that develops as the follicle grows.
Both illustrations are simplified. Colours and relative sizes help explain the structures; they are not ultrasound images or measurements.
What is an antral follicle count?
Most resting follicles are too small to see on a routine scan. As follicles grow, a fluid space forms inside them. These are called antral follicles.
During a vaginal ultrasound we can count the small visible follicles in both ovaries, often early in the cycle. This is the antral follicle count (AFC). It is a snapshot of the visible group, not a count of every egg remaining.
Where does AMH fit in?
Anti-Müllerian hormone (AMH) is made by cells surrounding eggs in small growing follicles. A blood test measures this hormone. AMH and AFC give related clues about ovarian reserve—the remaining egg supply—using different methods.
Why we measure it
It helps estimate how the ovaries may respond to fertility medicines, particularly for IVF or egg freezing. It can inform treatment planning and discussions about a low or excessive response.
What it cannot tell us
It does not count eggs precisely, measure their quality, give a reliable personal chance of natural conception, or tell you exactly how many fertile years remain. Age and the rest of the assessment still matter.
A low AMH does not mean pregnancy is impossible, and a high result does not guarantee fertility. AMH can be higher with polycystic ovaries and lower while using some hormonal contraceptives; results need context. We request it when it can help answer a clinical question, rather than using it as a pass/fail test before trying.
Further reading: ASRM: interpreting ovarian reserve and ASRM patient information on AMH and follicle counts (PDF).
06 / Treatment choices
Match the treatment to the reason.
Dr Adlam offers ovulation induction and intrauterine insemination (IUI). When IVF, ICSI or other specialist care is appropriate, we discuss referral. There is no requirement to try every option in a fixed order.
Some people benefit from treatment of a specific uterine or pelvic problem, donor eggs or sperm, or fertility preservation. These need individual counselling. More treatment is not always the right next step, and emotional support should be part of the discussion.
Patient information: ASRM: ovulation induction · ASRM: IUI · HFEA: IVF · HFEA: ICSI. ASRM guidance supports selecting and reviewing treatment rather than repeating cycles indefinitely.
07 / Planning the cost
Ask what the whole cycle includes.
A consultation fee is not the full cost of a treatment cycle. Medicines, monitoring scans, blood tests, sperm preparation and the IUI procedure may be billed separately. IVF also involves egg collection, laboratory work and embryo transfer, with possible additional freezing and storage fees.
Before starting, request a written estimate that lists what is included, what is additional, and what would be charged if a cycle is cancelled or repeated. Confirm medical-aid benefits and any authorisation requirements directly with your scheme; cover varies.
08 / Common questions
Bring your questions with you.
Can I book before I start trying?
Yes. This is a useful time to review medicines, health conditions and preparation, or discuss concerns about timing. You do not need to have difficulty conceiving before asking for advice.
Does a previous pregnancy rule out fertility problems?
No. Assessment can still be helpful if a later pregnancy is taking longer than expected. Mention all previous pregnancies and losses, including those with another partner.
What should I bring?
A medication list, period dates, previous scan or blood-test reports, semen results if available, and details of previous pregnancies or treatment. A short list of your priorities is useful too.
What happens if I become pregnant?
Arrange early pregnancy care and a medication review where needed. Ask reception about the appropriate care pathway and current maternity-service availability when you book.
Start with a conversation.
Discuss preparation, timing or a concern about conceiving.
Sources reviewed 26 September 2026. References are linked beside the relevant sections. General information to support an individual consultation; tests and referral depend on your circumstances.