Trying to conceive — the first diagnostic steps

When the wish for a child remains unfulfilled for more than a year, that is often the moment a couple first sits across from us. Not every workup has to happen at a fertility clinic.

Many questions can be answered at a gynecology practice — from cycle tracking and hormone profiles to ultrasound monitoring of ovulation. Only once this groundwork is done do we refer you onward.

Everything starts with a detailed conversation — ideally with both partners. How long have you been trying, how regular is the cycle, have there been pregnancies, operations or illnesses, what does everyday life look like? Even the seemingly incidental belongs here: medications, weight, exercise, smoking, shift work — much of this influences fertility more than people expect. Often, this alone gives us the first clues about where a closer look is worthwhile.

For the woman, the basic workup follows: cycle monitoring, in which we use ultrasound to track whether a follicle matures and ovulation takes place, plus blood hormone tests at defined points in the cycle. The thyroid is part of it too — an undetected thyroid disorder is one of the more common and most easily treatable causes. Depending on your situation, we add further values, such as prolactin or the anti-Müllerian hormone as an indicator of the ovarian reserve. Step by step, this builds a picture of whether — and when — ovulation takes place in your cycle.

A proper workup always includes the partner. In roughly half of all couples, the causes lie entirely or partly with the man — so a semen analysis, performed by a urologist or an andrology laboratory, belongs at the start of the process, not at the point when everything else has already been ruled out.

Much of what we find can be treated right at the practice: adjusting the thyroid, an irregular cycle, PCOS, unfavorable timing. Quite often, what is needed is not a major therapy but time, a better understanding of your own cycle — and the relief that comes with knowing the basics are sound. It also makes sense to start taking folic acid now — it belongs to the preparation for a pregnancy, not just to the pregnancy itself.

And when is it time for a fertility center? When the basic workup points to causes that call for further reproductive medicine — or when time is pressing, for instance from 35 onward, when we should not wait too long. In that case we refer you with a complete set of findings, which spares you weeks of duplicate testing at the center. And we remain your point of contact throughout the treatment there.

For many couples, an unfulfilled wish for a child is emotionally the hardest chapter of their relationship. We cannot promise the outcome — but we can make sure that at every point you know where you stand and what the next sensible step is.