Couples experiencing issues falling pregnant can be seen at Tamar O&G for their initial investigation and treatment. If possible, please come to your appointment with your partner.
If you have been having unprotected intercourse for 12 months (or 6 months if you have previously had children or are above 35 years of age), please obtain a referral from your GP to see any one of our Gynaecologists.
Please bring with you any investigations, including ultrasounds that may have been done previously. Male partners usually would have been asked to have a seminal analysis (a check of the sperm) which your GP may have organised. Please bring any results you may have.
What happens at your initial visit?
- a medical history will be taken including any prior operations, previous child bearing history (including any children born to previous partners). Any previous investigations done will be reviewed.
- you will have a basic physical examination done, including an internal vaginal examination, bacterial swabs (to exclude infections) and a pap smear if you are due for one. Male partners are usually not examined if the seminal analysis is normal, A limited examination is performed if you are worried about any abnormalities.
- If you need hormonal studies done, you will be given a pathology request form and instructed when to have these tests done (depending on your menstrual cycle). You may be asked to have hormone tablets to bring about a period prior to these blood tests.
- An ultrasound of the internal organs may be requested to exclude any abnormalities of the gynaecological structures. If you have been asked to have a hysterosalpingogram (HSG), you will be given instructions on when to have this done and how to book for the appointment at Regional Imaging.
- If your partner needs a seminal analysis, this may be done at any of the local pathology providers. You may be asked to send your sample to the Tas IVF lab at Queen Victoria Tower, Level 4, No 11 High Street, East Launceston. They can be reached at 6332.2000. Occasionally, an initial abnormality in the sperm testing may warrant an further analysis by our IVF colleagues.
At your follow up appointment:
- Results will be discussed with you and your partner. If you need follow up testing, this will be arranged for you
- If you have any questions or concerned, these can be discussed at this visit.
What happens next?
- most couples will have a normal investigation and may be asked to continue trying for a pregnancy naturally. If you are a smoker, consume alcohol excessively or are overweight you will need to make some lifestyle adjustments to optimise your pre-pregnancy health.
- some couples are suitable for medically assisted ovulation induction with an agent called Clomid or Letrozole (see Clomid schedule below). We will provide you with written instructions on how to take these tablets and when to have appropriate testing done.
- Cases that have failed simple ovulation induction, women who are 35 years and over, couples trying for a pregnancy for more than 2 years, couples with complex medical issues - including those with a genetic or inherited abnormality, and any patients who have previously received radiotherapy or chemotherapy will be referred to Tas IVF for further advice and management.
Clomiphene citrate (Clomid) / Letrozole schedule:
- Take Provera 10mg for 10 days. This is to bring about a period. You will be asked to have a pregnancy test prior to starting this tablet. If you have regular cycles, this step may not be necessary.
- When you have a period, treat this as Day 1 of your cycle
- Commence on Clomid or Letrozole between Day 2 and Day 6 (total of 5 days) of your cycle. The usual starting dose if 50mg per day of Clomid 2.5mg per day. You will be advised to change this dosage for subsequent cycles if necessary.
- Arrange for a follicular tracking scan (an ultrasound to see if your ovary is ready to ovulate) between Day 11 and Day 13 which can be done at either our Rooms or at Regional Imaging. You may be advised to avoid intercourse depending on the findings. Please call us when you have had your scan or advise us of your scan date so we can check the result and call you with the appropriate advise.
- You will have a blood test on Day 21 to check if your Progesterone level is elevated (a sign that you have ovulated).
- If you have not had a period by Day 29 or Day 35, please have a pregnancy blood test done. If it is positive, we will arrange further blood tests and and an ultrasound for you.
- If you have a period, please call our rooms for advise on the dose of Clomid / Letrozole to start between Day 2 and Day 6 of the next cycle.
If you have any questions or are unsure on what the next step is whilst taking Clomid, please call us for advise.
To read more about ovulation induction, please click here