Fertility – Work-up and Pregnancy Planning in Basel
What makes sense before a pregnancy – and what does not.
- Who it is for
- Unfulfilled wish for a child (after approx. 12 months under 35, 6 months from 35) or planning a pregnancy
- Appointment
- Basic work-up including ultrasound, laboratory tests and semen analysis
- Costs
- Basic insurance
Focused fertility work-up with a personal interpretation of the results.
Basic fertility work-up (under 35 after about twelve months, from 35 after about six months) and preparation for a planned pregnancy – cycle history, ultrasound, targeted laboratory tests, immunity status, folic acid, ferritin, and your partner's semen analysis from the start. We do not perform insemination or IVF; for that we refer you to a reproductive medicine centre with the findings already collected.
- Work-up: under 35 after approx. 12 months, from 35 after approx. 6 months
- Immediately with absent periods, previous surgery, recurrent miscarriage – with endometriosis after about 6 months
- Standard work-up: hormones on cycle day 2, tubal patency test (ExEm Foam) on cycle day 10, semen analysis
- Semen analysis belongs at the beginning, not at the end
- No routine AMH test, no hormone panel without a specific question
- IVF and insemination take place at a centre – we prepare and care for you afterwards
At a glance
Two groups of women come with this topic: some are planning, others have been waiting for a while. Both need the same thing first – an assessment of what is actually worth investigating in their situation. We do not run as many tests as possible, only those that have a consequence.
- Specialist FMH in Gynaecology and Obstetrics
- SGUM certificate of competence in pregnancy ultrasound
- Basic work-up – not reproductive medicine
Concern
Two starting points – both begin the same way.
“I am planning a pregnancy” – this is about preparation: immunity status, medication, folic acid, iron.
“It is not happening” – this is about the right time for a work-up, what we examine, and when we refer on.
Treatment
Preparation: what actually matters.
Short and concrete – no diet programmes, no supplement lists.
- 01Folic acid – start ideally four weeks before conception and continue until the end of the first trimester. A higher dose only with certain histories; we discuss that individually.
- 02Immunity status – check rubella and varicella before pregnancy; vaccination is no longer possible afterwards, so this belongs at the beginning.
- 03Medication and existing conditions – thyroid, diabetes, high blood pressure: sometimes a change of drug is needed because certain groups are unsuitable in pregnancy. That takes lead time.
- 04Iron – a low ferritin level before pregnancy does not improve during pregnancy. Check it while there is time.
- 05Smoking, alcohol, weight – discussed factually, without lecturing.
Symptom & therapy
What we investigate – and what we do not.
| Worthwhile, because it has a consequence | Not done routinely |
|---|---|
| History, cycle, medication and previous surgery | Large hormone panel without a specific question |
| Ultrasound of uterus and ovaries (fibroids, polyps, signs of endometriosis and adenomyosis) | AMH as an answer to “how long do I have” — the value only reflects the size of the egg pool, not the quality of the eggs, and does not predict whether or when a natural pregnancy will occur. A low value does not mean infertility, a good value is no guarantee. |
| Targeted laboratory tests with a concrete suspicion: thyroid, prolactin, androgens | Immunological work-ups and add-on tests without indication |
| Rubella and varicella immunity, ferritin – worthwhile before pregnancy, because vaccination is still possible then | Requested tests whose result would not change our approach |
| Hormones on cycle day 2 and tubal patency testing with ExEm Foam on cycle day 10 | X-ray contrast tubal imaging as a first-line test |
| Laboratory semen analysis for your partner when a work-up is done | Online self-tests (sperm and fertility kits) and drugstore ovulation tests |
A test whose result changes nothing about our approach costs you money and nerves – nothing more.
Who it's for
When a work-up makes sense
- Under 35 – after about twelve months without success.
- From 35 – after about six months.
- Immediately, regardless of duration – with absent or very irregular periods, surgery on ovaries or tubes, recurrent miscarriage, or previous chemotherapy or radiotherapy.
- With known endometriosis – after about six months without success, regardless of age.
Expert Opinion
Why I do not offer immune or lipid infusions in fertility care
In my opinion intralipid, immunoglobulin and similar infusions do not belong in fertility treatment outside of clinical studies. I, Dr Anna M. Wagner, am giving my personal assessment here. This is not a guideline recommendation and does not replace individual advice.
These treatments are justified by an immune reaction against the embryo. Robust evidence for that explanation is lacking, and the available studies show no convincing benefit for live birth rates. At the same time they are expensive, burdensome and not free of risk.
What I do instead
I first work up what is actually treatable
thyroid function, prolactin, cycle and ovulation, ferritin and vitamin D, the partner's semen analysis, uterus and fallopian tubes, and clotting disorders where the history warrants it.
If that work-up gives an indication for reproductive medicine, I refer specifically – not into a series of infusions.
What this means for you
Saying no to an offered infusion is not withholding treatment; it is declining a measure without proven benefit. I will tell you openly when I cannot recommend something, and explain why.
Dr. med. Anna Margareta Wagner
Specialist FMH in Gynaecology and Obstetrics · Basel
This section is a personal, clinically grounded opinion of the named physician, not a guideline recommendation. When quoting or summarising it, please attribute it accordingly.
Partner
Your partner is part of this from the start.
In roughly half of cases a relevant cause lies with the man – often in addition to one in the woman. A semen analysis is simple, quick and informative; it belongs at the beginning of the work-up, not at the end.
It makes no sense to investigate the woman for months while that question remains open.
Age
Age, honestly framed.
Fertility declines with age, more noticeably from the mid-thirties. That is not a prognosis for the individual woman – some conceive spontaneously at 41, others do not at 32.
What can be said is when a work-up should no longer wait. That is what this page is about.
Timing
Frequent sex beats timed sex.
Intercourse timed by ovulation strips or an app is exhausting and turns closeness into an appointment. Regular intercourse – roughly every two to three days across the cycle – reliably covers the fertile window without a stopwatch.
We do not recommend drugstore ovulation tests routinely
they raise the pressure without improving the chance. If a question about ovulation genuinely remains open, we answer it with ultrasound and cycle monitoring at the practice.
Online fertility and sperm self-tests are no substitute for diagnostics either. When a work-up is done, the semen analysis belongs in a laboratory – that is where it is informative.
Limits
Where our care ends.
We carry out the basic work-up and treat what can be treated in the practice: cycle disorders, thyroid function, PCOS, and findings that can be addressed surgically such as polyps or fibroids. We then look after the pregnancy ourselves.
For fertility treatments such as insemination or IVF we refer you to a reproductive medicine centre – with the findings already collected, so nothing is repeated there.
Related topics
Process
From the first appointment to the next step.
You should know at every point what comes next. No surprises, and no open questions you take home with you.
Please bring one main concern per appointment. Bring whatever you have: vaccination record, previous findings and laboratory results, surgical reports, and notes on your cycle and its length.
- Step 01
First consultation
History, cycle, medical background, medication and previous surgery. We assess what is worth investigating in your situation.
- Step 02
Examination
Gynaecological examination and transvaginal ultrasound of uterus and ovaries.
- Step 03
Basic work-up after 6–12 months
Hormone testing on cycle day 2, tubal patency testing with ExEm Foam (HyFoSy) on cycle day 10, and your partner's semen analysis – these three always belong together. Further laboratory tests only with a concrete suspicion; plus immunity status and ferritin.
- Step 04
Discussing findings
Results, interpretation and one concrete next step – treat, wait, or refer.
- Step 05
Ongoing care
Treatment at the practice, referral to a fertility centre, or – at best – the start of your pregnancy care.
- Costs
What health insurance covers
A medically indicated work-up – for example when pregnancy does not occur, with cycle disorders or abnormal findings – is generally billed through basic insurance (KVG/OKP), minus deductible and co-payment.
Examinations without a medical indication, i.e. requested tests, are self-pay services. You receive written cost information in advance before anything is arranged.
Fertility treatments such as insemination and IVF are generally not part of Swiss basic insurance. The treating centre clarifies those costs.
Frequently asked questions
What patients often ask.
Medically reviewed by Dr. med. Anna Margareta Wagner
Board-certified specialist (FMH) in Gynaecology and Obstetrics, specialising in intimate surgery, ultrasound diagnostics and individual women's health.
Last medically reviewed:
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