As fertility for a woman declines rapidly with age, a married couple who are ready to start a family should do so quickly. In general, a young and healthy couple can try naturally for 1-2 years before consulting a fertility specialist for review. The older woman (above 37 years) or those with symptoms suggestive of disorders of the reproductive system should seek help earlier. Significant symptoms include irregular menstrual cycles, painful menstruation, painful intercourse, painful defecation or chronic pelvic pain. Likewise, women with any pre-existing gynaecological conditions or hormonal disorders should also check with their gynaecologist regarding their ability to conceive naturally.

Pre-conception and fertility assessment may include the following areas:

  1. Full blood count and thalassemia screen
  2. Test of Rubella immunity (chickenpox and hepatitis B can be done too)
  3. Female’s ovulation status
  4. Detailed examination of the pelvis
  5. Fallopian tube patency
  6. Shape of womb cavity
  7. Sperm count

For selected couples, a detailed examination of the female pelvis with laparoscopy (keyhole surgery) may be recommended, especially if bedside examination reveals possible conditions that can be treated during laparoscopy.