Home Fertility Testing and Treatment
To most couples, having children is one of the most important aspirations of their family life. However when this doesn’t happen, there is the stress of booking into the GP surgery, often after waiting for an appointment, to possibly be told to try longer. There can be the added stress of waiting to be referred to a specialist clinic and followed by multiple appointments to make a correct diagnosis and be offered treatment. Technology has improved recently so that a couple can self check their fertility, be reassured if everything appears normal and seek early treatment if something abnormal is found.
There is the option now of checking to see if the female is releasing eggs through a finger prick blood test (progesterone). If she is worried about her overall fertility and how long she should put off starting a family, the fertility reserve (AMH) finger prick test is also an option.
If the AMH is borderline or low, she can preserve her fertility and halt the natural fertility decline that comes with time by having her eggs frozen. This acts as insurance, so that if she tries to become pregnant and experiences difficulties, her own younger eggs can be thawed and used to create a baby through IVF.
This website offers self testing in the comfort of your home and the reassurance of contact with a fertility specialist who can offer advice and treatment in order to fast track achieving a family.
The human sperm count is in a rapid decline. For a man, this is his sperm count.
In the 1930's the average count approached 100 million sperm per mill of semen. In 2017 the World Health Organisation re classified normal to be only 15 million per mil. By 2060 if this continues men will no longer be able to father children through intercourse, all children will be conceived with IVF. This decline is assumed to be due to the introduction of plastics, fertilisers, pesticides and toxins into our diet, contamination in the water we drink from oestrogen hormones (e.g. from the contraceptive pill) and pollution in our environment from vehicles and factory waste. In addition, carrying mobile devices (e.g. WiFi using laptops/mobile phones) in close proximity to the testicles are also known to be detrimental to sperm.
Figure from E Carlson et al British Medical Journal 1992;305:609
Fortunately there is evidence that this effect can potentially be somewhat reversed by eating healthily i.e. cutting out processed food, not smoking, drinking little alcohol maintaining a healthy weight and exercising regularly.
There is also help available through fertility vitamins that reduce the effects of the reductions in sperm count that is associated with a western lifestyle. One of these is Impryl which benefits both men and women’s fertility.
In the last few years with the advances in technology, it is now possible for a man, in the comfort and privacy of his own home, to check his own sperm count. This is done with an FDA approved kit that uses a miniature camera in either the kit or your own phone to check the count and video the sample to check sperm numbers and swimming percentage (motility).
These numbers are quantifiable and given as a score from 0 to 100.
If the numbers are low, then a change in life style and vitamins can be attempted and the test repeated to see if the score improves. If the score remains poor then a test tube baby with sperm injected into the eggs (ICSI) will be required.
There are 2 options for a woman
When she is actively trying to become pregnant.
When she wants to know whether she has normal fertility (or a normal number of remaining eggs for her age) and can possibly put off becoming pregnant or have her eggs frozen if starting a family will be in the future.
Having a baby now
The most important test is to check that you are releasing an egg each month. If you have a regular 28 day cycle from the 1st day of a period to the 1st day of the next, then the blood test should be done on day 21 i.e. 3 weeks form the 1st day of your proper period, not spotting. If your cycle isn’t regular then the test should be 7 days before the start day that you expect your next period. The test is done by purchasing the kit when you collect a few drops of blood into the small pot, all included with instructions in the kit, and posted to the lab in the reply paid envelope. You will then get an email within a week of the results with treatment recommendations if required. The expected normal is 30 or above. If it is low then a simple tablet prescription will solve this.
Obviously if you know that you have had a significant pelvic infection in the past this is only one fertility test and a tubal flush or (HYCOSY) should be considered to check your Fallopian tubes are open to pick up the released eggs.
Having a baby later
Female fertility unfortunately declines with age. Although most women are very fertile at 25 with a 1 in 4 chance of natural conception a month, this declines significantly with age to very low in the 40’s. This decline in a woman’s fertility with age is considered to be almost exclusively due to the quality of her eggs declining. It is now possible for a woman to preserve her fertility and halt the ageing of her eggs by having her eggs frozen when young (i.e. ideally under 35) to be used later up to the age of the natural menopause in the 50’s.
Until recently this was thought to be be useful for women with major medical issues e.g. cancer, or severe endometriosis with ovarian cysts damaging her ovaries. However with social changes meaning many women electively put off starting a family way past their fertility peak it is now possible via a simple finger prick test to check your fertility reserve in the comfort of your home (AMH blood test) and receive a report as to where you are on the fertility time scale. The AMH (Ante Mullerian Hormone) produced by the ovaries in proportion to the number of remaining eggs, shows where you are on the fertility time scale. A high level with PCOS (link to site PCOS) means eggs aren’t released so fertility reserve is high. A ball park figure over 10 is good for fertility now, but not if you are under 25 when the lower normal is 15. A level of over 5 is required to have a good chance of quality eggs at IVF.
Until recently this was experimental, but now hundreds of healthy babies have been born with frozen stored and then thawed eggs
Basically this technique is 2 weeks injections with ultrasound monitoring leading to an egg collection as in ivf but the eggs frozen without being fertilised and stored initially up to 10 years
The number of eggs required is completely dependant on a woman’s age.
The following was published in Human Reproduction in 2017 and gives a very good indication of the number of eggs required at a given age to have one baby. Obviously if more babies are required then more than one cycle of egg collection can be done and produce more eggs for multiple chances later when they are thawed fertilised with sperm and put back in your womb.
In our society it is considered by many healthy women a good insurance for the future to put a halt on the biological ageing of their eggs so that when the right time comes to start a family, if a baby doesn’t happen, then their own young eggs are available.
This graph from Goldman RH et al
shows e.g. that 10 eggs in the freezer will give a 35 year old woman or younger a 70% chance of a baby but these 10 eggs from a woman who was 44 when her eggs were frozen, would only give an 8% chance of having a baby. Or put another way 100 eggs (a practically unachievable number) in the freezer for a 44 year old women at the age her eggs were frozen would result in a 55% chance of a baby. So the earlier you consider egg freezing, if it is important for you, over the age of 25, the higher your chances of having a baby.
Ten percent of women have this condition where the eggs aren’t often released and there is a resistance to insulin causing weight gain. This is reversed by a combination of folic acid and Inositol a naturally occurring compound in our healthy cells. This products marketed as Inofolic taken as 2 sachets a day dissolved in water enables 70% of women to regain their fertility by releasing eggs.
Low Fertility Reserve Treatment
There is a good body of evidence to suggest that the hormone DHEA, which is a precursor of approximately 10 different steroid hormones and reaches a maximum in the late teens to early 20s in both men and women but declines as we age, can be supplemented to improve the quality of the eggs once a woman prematurely ages with a low AMH. Although it won’t reverse the menopause, DHEA can contribute towards achieving more eggs of a higher quality after it is taken at 25 mg three times a day for 3 months than would otherwise have been achieved.