Blog
Dr Christopher Ng
Consultant Obstetrician & Gynaecologist
MBBS (Imperial College, UK), MMed (O&G) (Singapore), FRANZCOG (Aust-NZ), FAMS (O&G) (Singapore)
When a couple has been trying to conceive for some time, they may be left with many questions about why pregnancy has not happened and what they should do next. An infertility assessment can provide an opportunity for couples to receive advice and guidance from an infertility specialist.
During these assessments, your doctor aims to provide greater clarity by looking at factors that could be affecting either partner’s fertility, then bringing these findings together so that you can understand what they mean and decide on your next steps.
Your first infertility screening is meant for your doctor to understand your experience of trying to conceive and identify areas that may need closer assessment. Both partners may be involved, as fertility difficulties can be related to female factors, male factors or a combination of the two.
During the consultation, your doctor may discuss:
This initial discussion helps your doctor understand where further assessment may be useful. From there, they can recommend fertility tests.
After discussing your history, your doctor can begin assessing different parts of the reproductive process to look for factors that could be making conception more difficult. This can involve checking whether ovulation is occurring, examining the reproductive organs, assessing whether the fallopian tubes are open and evaluating sperm health.
Understanding whether ovulation is occurring regularly is an important part of assessing female fertility. Your doctor will consider your menstrual cycle and may arrange blood tests to measure hormones involved in ovulation and reproductive function.
Ovarian reserve testing may also be performed to provide information about the remaining supply of eggs in the ovaries. Tests such as anti-Müllerian hormone (AMH) testing and an ultrasound assessment of the follicles within the ovaries can contribute to this evaluation.
A pelvic ultrasound allows your doctor to examine the uterus and ovaries more closely. During the scan, your doctor can assess the ovaries and developing follicles as well as the structure and lining of the uterus.
It can also identify findings such as ovarian cysts, fibroids or other structural changes that could be relevant when building an overall picture of your reproductive health.
The fallopian tubes provide the pathway through which the egg and sperm meet, so your doctor may recommend checking whether they are open. A tubal patency test can help identify whether one or both tubes are blocked or whether there are other findings that could interfere with conception.
Your doctor will explain the type of tubal assessment being recommended, what the procedure involves and when it should be performed within your menstrual cycle.
Male fertility is commonly assessed with a semen analysis. You will be given instructions on providing a semen sample, which is then examined for factors including sperm concentration, movement and morphology.
The results can indicate whether sperm-related factors could be contributing to difficulties conceiving. If an abnormality is identified, your doctor can explain whether the test should be repeated or whether further assessment is appropriate.
The tests performed during an infertility assessment are selected to build on what your doctor has learnt from your consultation and earlier findings. Once the relevant assessments have been completed, the next stage is to look at the results together.
Once your test results are available, your infertility specialist will review them alongside the information gathered during your initial consultation. Reviewing the findings together can help identify factors that may be affecting conception.
Your doctor will talk you through the results and explain their significance for your fertility. In some couples, the assessment identifies a specific factor that could be affecting conception. In others, the initial tests may indicate that further assessment would be useful. It is also possible for standard fertility testing to find no clear explanation for why pregnancy has not occurred, which is known as unexplained infertility.
By the end of this review, you should have a clearer understanding of what the assessment has found and what those findings mean for the options available to you.
The next step is to discuss the available options with your doctor. Depending on the findings, this may involve addressing an identified fertility problem, continuing to try naturally with guidance or considering fertility treatment.
If the assessment identifies a condition that could be making conception more difficult, your doctor may recommend treating it first. This could include medication to support ovulation or treatment for conditions affecting the reproductive organs. In selected cases, surgery may be considered for conditions such as fibroids or endometriosis, depending on the findings and their potential effect on fertility.
Some couples can continue trying to conceive naturally with guidance from their doctor. This may involve monitoring ovulation and identifying the fertile window so that intercourse can be timed when conception is more likely.
Your doctor can also advise you on how long to continue trying before returning for a review.
If you need additional help to conceive, your doctor may discuss assisted fertility treatments with you. These can include superovulation intra-uterine insemination (SOIUI), where prepared sperm is placed into the uterus around the time of ovulation, or in-vitro fertilisation (IVF), where eggs are fertilised with sperm outside the body before an embryo is transferred into the uterus.
Your doctor will explain why a particular treatment is being considered, what it involves and what you can expect if you decide to proceed.
After you start trying or begin treatment, your doctor can review your progress with you. If you do not conceive, the next discussion may be about trying again, making changes to the current treatment or considering another fertility treatment.
Completing an infertility assessment gives you and your partner information that can be used to make practical decisions about trying to conceive. Whether this involves addressing an identified fertility problem, continuing to try naturally or considering assisted fertility treatment, you can move forward with a better understanding of the factors involved.
At GynaeMD Women's & Rejuvenation Clinic, Consultant Obstetrician & Gynaecologist Dr Christopher Ng provides infertility assessment and fertility care for couples who are trying to conceive. He takes a personalised and evidence-based approach to fertility care, considering both partners’ reproductive health when assessing possible fertility factors and the options that may be appropriate. Through his efforts, he aims to help patients understand their situation more clearly and make informed choices about how they wish to proceed.
Book an appointment with Dr Ng to discuss your fertility concerns and your next steps.
Dr Christopher Ng
Consultant Obstetrician & Gynaecologist
Qualifications & Credentials
Dr Christopher Ng is a consultant obstetrician and gynaecologist with over three decades of experience in women's reproductive health. Having received medical education and training in Singapore, the UK and the US, his clinical experience includes fertility assessment and treatment, as well as laparoscopic surgery for gynaecological conditions that may affect fertility.
At GynaeMD Women's & Rejuvenation Clinic, Dr Ng provides personalised fertility care, including IVF and SO-IUI treatments. He takes a considered approach to helping individuals and couples understand their reproductive health, explore suitable treatment options and make informed decisions about their fertility journey.
