The Centers of Disease Control and Prevention defines infertility as not being about to achieve pregnancy after one year of unprotected sexual intercourse. For women 35 years of age and younger, the timeframe is around six months. Women who do not have regular menstrual cycles are at risk for infertility. If you and your partner are considering fertility testing, factors to consider are the age of the female partner, the overall health of the couple, and the couple’s medical history.
At your first appointment with a reproductive endocrinologist or fertility specialist, you will meet the physician. This initial consultation involves asking questions about the possible causes of your infertility. The doctor will inquire about your medical history, family history, social background, work, and hobbies. If you have any questions or concerns about becoming pregnant, you should discuss them during this initial consultation.
After your initial consultation, couples will be given a fertility evaluation. For the woman, this consists of testing ovarian reserve, evaluating ovarian function, and assessing reproductive structures (uterus, fallopian tubes, and ovaries). Testing will involve:
Blood work – To check hormone levels (pituitary gland, thyroid, and ovaries).
Hysterosalpingography (HSG) – To evaluate reproductive structures.
Genetic testing – To see if genetic defects are present.
Pelvic ultrasound – Used to investigate reproductive organs.
For the man, a semen analysis will be done, along with a physical examination to assess reproductive structures (penis, vas deferens, testes, prostate, and scrotum). In addition, the doctor will check hormone levels and perform an ultrasound to assess the organs.
Female Infertility Course of Action
After all testing is done, the fertility specialist will meet with the couple to discuss treatment options. We customize each couple’s treatment plan, considering family goals, emotional state, and past medical history. For the woman, considerations include:
Age – Aging greatly impacts the female reproductive cycle, and age is the best predictor if or not the woman will conceive with her own eggs. After age 40, the odds fall considerable, and miscarriage and chromosome abnormality rates rise. For older women, options include egg donation and in vitro fertilization.
Ovulation – Without ovulation, the couple cannot conceive. Menstrual cycles are irregular due to polycystic ovarian syndrome, thyroid dysfunction, and premature ovarian failure. Many women who do not ovulate regularly can be induced using oral or injectable medications.
Ovarian reserve – We test ovarian reserve using special blood tests (day 2-3 FSH and Estradiol levels), as well as using ultrasounds.
Tubal status – Endometriosis, infection, and surgery can cause the fallopian tubes to become scarred, kinked, or distorted. Blockage will prevent the egg and sperm from coming together for fertilization. To evaluate patency, we use HSG testing. When this is a serious problem, in vitro fertilization is an option.
Uterus – Polyps, fibroids, and scarring from surgery can affect the uterus and endometrium (uterine lining). Failure of the embryo to implant can result in miscarriage. We check for function using ultrasounds and a mild procedure (hysteroscopy).
Male Infertility Course of Action
Around 35% of all cases of infertility are attributed to a male factor. We assess and test for:
Sperm count – Even when a female factor is identified, we assess the man’s sperm count. Options include intrauterine insemination, intracytoplasmic insemination, and sperm donation.
Sperm function and integrity – The sperm should be able to penetrate the egg. In rare cases, the sperm does not function or move correctly and cannot enter the egg. When this occurs, it can be placed inside the egg in the laboratory setting. Using a special test, the fertility specialist checks sperm for DNA fragmentation. When this occurs, a sperm donor is an option.
Sexual dysfunction – Structural and psychological issue can affect ability to get an erection. This can be treated with medications and counseling.