How to talk to your GP about fertility concerns

Are you worried that conception isn’t happening as quickly as you expected? If you have fertility concerns, your GP is your first point of contact to access NHS help. So how do you best prepare for that all-important first appointment? Let’s take a closer look…

The beginning of the Trying To Conceive (TTC) journey is such an exciting time – filled with hope and possibility. But as the months pass, things start to feel different, and you might start to wonder ‘why not me’?

There are lots of different kinds of ‘normal’ when it comes to fertility, and though some couples get lucky on their very first cycle, for many others it can take years. But at what point should you seek medical help – and when it comes to discussing your fertility with a doctor, what should you be ready to talk through, and what to prepare in advance.

When to seek help?

The NHS suggest that you try for a year if you’re a woman and under 36, unless you have a specific concern about your fertility – such as having had cancer treatment. Age-specific guidance isn’t provided when it comes to the male partner.

However, there is a lot you can do in that year of trying – both to give yourselves the best chance of conception, and to speed up the process if you eventually need a helping hand.

If you’re over 36, there are mixed opinions, but many medical professionals suggest that you seek help after 6-12 months. We fall in the sooner-is-better camp – if there is a medical issue, the sooner it’s sorted, the better your chances of success.

What to expect

GP appointments tend to be quite short – depending on your practice, between 5-10 minutes. So it’s a good idea to see your initial appointment as a ‘warm-up’ rather than the ‘main event’. Aim to come away having explained your situation and circumstances, and having made a plan together for the next steps to investigate. Try and see the process as just that: a process that will likely take a few appointments and actions before too much happens!

Feeling frustrated already? That’s understandable. When you’ve been waiting for months – or longer – already, you may feel like you’re being ‘fobbed off’. So it’s really important to be prepared, calm and in control to make the most of the time and resources available.

What might be discussed

In your initial appointment, your GP will ask you some pretty personal questions, so be prepared! These will include:

• Whether you have ever been pregnant before if you're the female partner seeking to conceive.
• If the male partner or sperm donor has fathered a child before.
• How often you have sex – and if there are any issues.
• How long you’ve been trying without contraception.
• If either of you have – or have had – any STIs.
• How much you both drink.
• Whether you smoke or take any prescribed or recreational drugs.

Try not to be embarrassed, and remember they have had this same conversation with thousands of other people. They are there to help you – not judge you – and if you feel uncomfortable, don’t be afraid to say that you need to slow down or take a minute. You may want to attend as a couple, or you may wish to make two separate appointments if that’s more comfortable.

What might happen next?

If you're under 40, you may be asked to keep trying for a little longer – or you may be offered medical investigation and help. However, what’s on offer will depend on your age and how you answer your GP’s questions. Depending on what comes up in your chat, the next step will probably be some investigation, which might include:

• A physical examination – for one or both partners.
• Blood tests for the female partner, to check on gonadotropins and/or progesterone.
• Ultrasound for the female, to check ovaries, uterus and fallopian tubes.
• Chlamydia tests for both partners.
• Sperm analysis for the potential father.

These tests will flag any potential issues, and help you and your medical team decide the next best step – more on that to come.

Understand your options

It’s a good idea to be aware of the NICE recommendations on NHS IVF availability AND the CCG guidelines in your area before your GP appointment. In short, NICE suggests:

• 3 x cycles for women who are under 40 who have been trying for 2 years of age.
• 1 x cycle for women 40-42 (this is heavily caveated).

However, whether you will be able to access this in reality actually depends where you live. Your local Clinical Commissioning Group (CCG) actually holds the purse strings and may have a different policy.

Horribly, it really is a postcode lottery. In some areas, CCGs won’t fund treatment past a certain age, and that can be much younger than you’d think. There may also be surprising exclusions and caveats, such as you must be within a specific BMI group, must have been a couple and been trying for 2+ years, you mustn’t smoke, there must be no children from previous relationships (either partner)... the list goes on.

It’s well worth knowing your local CCG policy up front, because your GP makes notes at every chat. These will be added to your file and could impact on your options down the line – there’s no going back and changing what you’ve said.

What to prepare

As well as reading up on your CCG’s policies on assisted conception – if that’s a route you’d consider if needed – you might want to do some ‘extra homework’. It can be all too easy to get a bit tongue-tied when you are being asked lots of very personal questions, so make some notes beforehand on any questions you would like to ask in return.

You might be keen to know:

• What’s the overview – and the immediate next steps – in your care plan?
• Should your partner make an appointment if you aren’t already attending together?
• What tests will be undertaken – and what to expect from them?
• How long will you be waiting for test appointments – and when should you chase them up if you don’t hear back.
• Is there anything more you can both do from a lifestyle perspective to enhance your chances?

Self help in the meanwhile

Getting a GP appointment and waiting for subsequent investigations all takes time, so there are some steps you can take to enhance your chances while you wait.

Get the basics right – start with looking into nutrition for both him and her, and cut down on alcohol and quit smoking, if you haven’t already – that all counts for both partners. It’s also a good idea to take a decent fertility supplement.

Get moving – it’s a good idea to work on your physical fitness if you aren’t already regularly exercising. And if you are, be aware that too much exercise can actually have a negative effect on your ability to conceive – low body fat can actually lead to anovulatory cycles – so make sure your regime is balanced and healthy.

Keep an eye out for irregularities – has anything changed physically? Have you noticed any lumps and bumps, changes in smell, sensation or skin texture? This goes for both partners – dads-to-be aren’t always checked out early by GPs, so be self-aware and flag any changes.

Keep having regular sex – sounds like a no-brainer, but your GP will ask about this. At least once every 2-3 days throughout the month is the NHS recommendation.

Track your cycle and LH surge – as well as counting the days between periods, tracking your LH surge is a great way to spot any issues with ovulation (as well as predicting the best days to have sex). If you do this with a personalised tracker that works for women with irregular periods and PCOS, you’ll be helping your GP with vital clues about any potential tricky ovulation issues from the start.

Useful resources:

• The ABCs of natural conception.
• How to find your local Clinical Commissioning Group (CCG).
• Information on fertility treatments available through the NHS.