Community leaders Kathy and Paula from the fertility issues message board have put together clear answers to some of the common questions couples ask when facing the prospect of fertility treatment.

HOW DO I CHOOSE A FERTILITY CLINIC?

There are a number of factors to consider when choosing a clinic, and your personal preference will let you decide which factors are more important for you.

• Success Rates
  Success rates can be misleading, as clinics report their success rates differently. Some report the number of live births, while others only report the number of pregnancies, which can be misleading. Some clinics report on women of all age groups, while others split their results by age group, which will give a more accurate picture. Some clinics may exclude patients that have a poor chance of success, so their success rate looks better than those clinics who take patients regardless of chance of success. Make sure you fully understand how they compile their statistics
• Cost of Treatment
  Do their prices include or exclude the cost of drugs? Do they offer a reduced rate for a multiple treatment package? Will they offer a reduced rate if you are able to be an egg sharer?
• Clinic Location
  You will be visiting your clinic regularly during a treatment cycle, consider how you'll get there. If the clinic has a satellite agreement with a clinic or hospital closer to where you live, you may be able to undergo some of your treatment at the local clinic
• Types of Treatment Available
  Does the clinic offer a full range of treatment, DI, IUI, ICSI, PESA, TESA, IVF, GIFT, ZIFT, etc. Do they offer frozen embryo storage, blastocyst transfer, laser hatching? Do they have criteria for freezing frozen embryos? Some clinics will only freeze over a certain number, and some insist on only freezing those embryos with a high cell count. Do they run a sperm and egg donor service, and how long is their waiting list? Check that the clinic has a current license for the treatment you wish to undertake
• Infertility Counselling
  All clinics offering licensed fertility treatments MUST, by law, offer free counselling, and this should be available at all stages of treatment. Does the clinic also have a patient support group?
• Environment
  It is wise to visit a prospective clinic and ask for a tour to get the feel of the place. Are the staff welcoming, warm and friendly? Are they happy to answer questions? Do they have women consultants available if that is important to you? Click here for a list of all licensed IVF clinics in the United Kingdom according to county/area

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WHAT WILL HAPPEN AT MY FIRST FERTILITY APPOINTMENT?

Take the following with you if applicable:

• A list of any questions you may have so you don't forget to ask anything
• A history of your fertility (summary of any previous treatments). If you have undergone fertility treatment somewhere else, you're entitled to write to the clinic and ask for a report with your treatment details
• Blood test results
• Semen analysis
• Reports of previous examinations such as x-rays and any operations that you may have had.

The initial consultation lasts approximately 1 and a half to 2 hours, and you will need to take your partner with you. You may be asked to arrive 20 minutes before your appointment, to register with the clinic and complete forms.

Your consultant will take a full and comprehensive medical history of both partners, if applicable. You will be asked to undergo a physical examination. If for any reason you do not wish to have the examination at this stage, do inform your consultant. A nurse should be present at the time of examination to assist the consultant.

The examination may include a breast and gynaecological examination, including a cervical smear and, possibly, a mock transfer where they will ensure they can insert a catheter into your uterus. You may also have an internal ultrasound to check your uterus for fibroids, and your ovaries for cysts. Male partners will also be examined, if necessary, and may be asked to provide a semen sample for analysis.

The ultrasound findings and the result of the semen analysis will be ready towards the end of the consultation. The consultant will explain the findings, and together you will discuss the different options available, regarding your future fertility treatment.

Further diagnostic tests such as x-rays, laparoscopy and hysteroscopy and blood tests may be necessary - these will also be explained.

Normally, at the end of the consultation you will be asked if you have any questions, or if there is anything you would like explained again. Don't be shy about asking questions or getting them to repeat themselves. It is important that you walk away from this appointment with all the information you need to proceed with treatment.

Note: It is vital that couples realise that making the diagnosis is very important, and that they should not be 'rushed' into having IVF just because it has a higher success rate. For many couples, ovulation with IUI (Intra-uterine insemination) provides a better cumulative chance of pregnancy, and it is much less invasive and expensive.

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I HAVE TO HAVE BLOOD TESTS - WHAT ARE THEY FOR?

Infertility Investigations

• CD2/3: The cycle day 2 or cycle day 3 blood tests are normally for follicle stimulating hormone (FSH) and luteinising hormone (LH). They give an indication of the potential supply of the eggs that are ripening in your ovaries. The quality of the eggs tends to depend on your age
• CD21: Progesterone is measured on cycle day 21 of a 28-day cycle. For this test to be accurate it needs to be performed 7 days after you ovulate and, depending on your cycle length, that may not be cycle day 21. Progesterone indicates that ovulation has occurred.

They might also want to test:

• Prolactin: Too much prolactin (milk hormone) may prevent ovulation. If the prolactin level is elevated, the test needs to be repeated to confirm that it is a persistent problem. prolactin levels can increase due to stress.
• Thyroid Hormone Levels: If a woman's thyroid gland is under-active, it can interfere with ovulation and the quality of eggs that she releases.
• Oestrogen (Estradiol test): Makes the cervical mucus agreeable to the entry of sperm, prepares the endometrium (lining of the uterus) and regulates the production of FSH (follicle stimulating hormone) and LH (luteinising hormone).
• Antiphospholipid Syndrome or Sticky Blood: This test is normally only offered if there is a strong family history of deep vein thrombosis (DVT) or pulmonary embolism (PE) or if there is a history of recurrent early pregnancy loss. People with this syndrome have an increased tendency to form clots in blood vessels. In pregnancy small clots can affect the placenta and there is an increased risk of miscarriage, particularly in mid-pregnancy.
• Testosterone: Testosterone levels can be raised in some women and this can interfere with the menstrual cycle. This test would only be offered to a woman with signs or symptoms suggestive of PCOS (polycystic ovary syndrome).

Before Starting A Treatment Cycle
You may be asked to have HIV, Hepatitis B & C blood tests. You may also be tested for other STDs. Some clinics might not treat you if these are positive.
Note: In the UK, only 3 clinics are equipped to treat couples with these conditions.

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HOW CAN I TELL WHEN I'M OVULATING?

There are only a few days each month when you are fertile and can conceive, and these are around the time of ovulation. To increase your chance of getting pregnant, you should make love on the days leading up to ovulation and the day of ovulation. There are various methods you can use to find out when you are ovulating.

Ovulation Predictor Kits (OPKs): An OPK aims to find the two most fertile days in your cycle by identifying the surge of luteinising hormone (LH) that appears 24 - 48 hours before you ovulate. Each kit contains 5 test sticks. The kit contains details of when in your cycle you should start testing, based on the lengths of your shortest and longest cycles. If you have very irregular periods, you may need to use more than one box of tests in a single month.

Some kits suggest using early morning urine for testing, others suggest using afternoon urine. You can either hold a test in your stream of urine, or collect some urine in a container and test that. You must then look at the 'surge line' and the 'reference line' on the test. If the surge line is as dark, or darker than the reference line, the LH surge has started and ovulation is imminent. If the surge line is lighter than the reference line then you must do another test the following day. Once you have detected an LH surge, you do not need to continue testing each day.

Persona: Although Persona is meant as a natural contraceptive, it can also be used in reverse as an aid to identify ovulation time. Persona consists of a monitor and test sticks, which are used to check hormones found in your early morning urine. You have a 6 hour window each day in which to perform your test.

When your period starts you press a button on the monitor. A green light indicates that you are probably not fertile and a red light indicates that you are in your fertile period. There will be a yellow test light on 8 mornings each month (16 during the first month of use) and you must perform a urine test on these days, so that the Persona can determine whether to give you a green or red light.

The monitor reads the test stick for you and will then show the appropriate light. You must use test sticks from the same batch each cycle. An 'O' symbol appears on the monitor when it believes ovulation is due to happen in the next couple of days. A flashing 'M' symbol appears on the monitor when it detects that your period is due to arrive.

Saliva Testing: A saliva tester is a re-usable mini microscope, which allows you to look at the structures in your saliva. During your fertile period, a dried sample of your saliva will contain many structures that look like ferns. On all other days of your cycle, your dried saliva will only contain shapeless dotted structures.

To test, you must place a sample of saliva on the slide, allow it to dry and look at it under the microscope. After the test is complete, clean and dry the slide in preparation for testing on another day. Avoid eating, drinking alcohol and smoking for 2 hours before testing.

Cervical mucus can also be used instead of saliva for testing.

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Checking Cervical Mucus: The consistency of your cervical mucus changes throughout your cycle. In the days leading up to ovulation, the amount of oestrogen in your body increases which causes your cervical mucus to become stretchy and clear. The mucus becomes more alkaline and hospitable to sperm.

After ovulation, the oestrogen levels fall and your cervical mucus will tend to dry up. You can check your cervical mucus internally or externally, by wiping the outside of your vagina and observing the mucus that appears.

Check to see if the vagina feels wet or dry. Look at the mucus and check its colour, consistency, the amount of mucus present, and whether the mucus can be stretched between your finger and thumb.

Cervical mucus is normally described as dry (there is no mucus), sticky (the mucus forms little balls when rolled between finger & thumb), creamy (it has the consistency of body lotion and feels cold), watery (it is clear and wet feeling) or egg white cervical mucus (ewcm) (which has the consistency or raw egg white and will stretch between your finger & thumb).

Not all women will get ewcm or they may see it on the days running up to ovulation but not on the day of ovulation itself. When your cervical mucus becomes more watery or becomes ewcm and when your vagina feels wet or lubricated, it is likely that ovulation is going to occur in the next few days. Be aware that some women have more than one patch of watery or ewcm mucus in a single month.

Checking Cervical Position: Your cervix changes throughout your cycle. Around the time of ovulation your cervix becomes soft and open and is felt higher in your body and feels wet. At other times it feels firm, closed, low and dry.

To check your cervical position, wash your hands thoroughly. Always be in the same position when checking your cervix, otherwise you may think that your cervix is higher or lower than it actually is.

Put one or two fingers into your vagina. You should be able to feel the cervix towards the back of the vagina and it feels slightly different to the surrounding tissue.

Feel your cervix and see whether it feels soft or firm, closed or open, wet or dry and whether it is high or low. If you have already had children, your cervix will always feel slightly open.

Checking Basal Body Temperature (BBT): Checking BBT will not help you predict when ovulation will occur, but it may help you determine when ovulation has occurred and so help you gain a better understanding of your own menstrual cycle.

Before ovulation, your temperature is normally slightly lower. After ovulation, progesterone is released and your temperature rises by about 0.4 degrees Fahrenheit or 0.2 degrees Celsius. You should use a BBT thermometer to check your temperature and most ladies find a digital thermometer is easier to use.

Take your temperature each day before you get up, eat, drink, smoke etc. Ideally you should take your temperature at the same time each day and use the same thermometer throughout your cycle. Your temperature can be taken orally, vaginally or rectally. If you snore, it is advisable not to take your temperature orally. Use the same method throughout your cycle.

Record your temperature either on a chart or using one of the many online charting websites. Be aware that your temperature may be affected if you are unwell, have drunk alcohol, have had less than 3 hours uninterrupted sleep before taking your temperature or if you have taken your temperature at a different time to normal.

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WHAT HAPPENS WHEN I HAVE A HYSTEROSALPINOGRAM (HSG)?

A hysterosalpinogram (HSG) is an x-ray examination of the fallopian tubes and uterus, which checks to see if the cavity of the uterus is normal and whether the tubes are open. It is normally performed between day 7 and 10 of your cycle and takes about 30 minutes to perform and does not usually require a general anaesthetic. Some hospitals suggest you take a painkiller before having the procedure.

You will be asked to undress and put on a gown. Take a sanitary towel with you, for use after the examination. You will be asked to lie on your back on an examination table. The doctor may perform a quick internal examination of your vagina to check the position of your cervix before inserting a speculum into your vagina. This is the same instrument that is used when you have a smear test and allows the doctor to see the cervix.

A small plastic tube is inserted into your vagina, through your cervix and into your womb. You may feel slightly uncomfortable as this happens. A colourless liquid, which shows up on x-rays is flushed into the fallopian tubes and then spills out into the abdominal cavity. X-ray pictures are taken while the dye is flowing through the organs. Some women feel a sharp pain, similar to period pains as the liquid travels into each fallopian tube.

You may be able to watch what is happening on a TV screen. The doctor may tell you the result of your HSG immediately, or you may have to wait for a follow up appointment. After the examination you may feel period like pains and have some discharge, which contains the dye and also some blood.