Mother Nature vs. Infertility Treatment
Still not pregnant? When to seek infertility treatment and when to let nature take its course.
When to Get the Full Infertility Workup
After trying for one year, doctors may recommend a full infertility workup.
They may opt to do this sooner if the couple is aged 35 or older, says Mindy
Shaffran, MD, a reproductive specialist at East Coast Fertility in Plainview,
"After the age of 35, it is recommended that couples try for six months
instead of a year," she says. "The majority of couples will be successful in
that time, and if you are not, there may be things that we want to catch sooner
rather than later."
"Fertility declines rapidly after age 35 and sometimes it gets to the point
where we can't really help," she says. "It behooves women in this age group to
start the process earlier even if they would have gotten pregnant on their own
so they know that there is not any particular problem that they need to
overcome," she says.
There are many possible causes of infertility, and a full workup will try to
identify exactly which is causing the problem. Doctors will examine potential
causes of both male infertility and female infertility. The results
will help dictate and guide infertility treatment.
The process starts by consulting an infertility specialist, like Shaffran.
The full workup will entail a semen analysis for the man. In women, the
infertility workup consists of blood testing to check levels of thyroid hormone and other hormones, a Pap test to check
for changes in the cells of the cervix or infection, and a hysterosalpingogram (HSG), an X-ray procedure that makes sure
that the fallopian tubes are open. The HSG can also detect any abnormalities in
Sabanegh often suggests that men get tested first. "Routine semen analysis
is quick and relatively inexpensive," he tells WebMD. "Before we put women
through invasive, expensive, and painful tests, we better have a pretty good
idea that those tests are necessary," he says.
For couples who want to complete the evaluation as rapidly as possible,
Shaffran says she will initiate a workup on both partners simultaneously. "Many
couples will often have more than one factor at the root of their
Troubleshooting Your Fertility Problem
If a problem is identified in terms of the ovulation process, the first-line
infertility treatment is typically Clomid or Serophene, drugs that
work by stimulating ovulation. "This is usually paired with intrauterine
insemination (IUI)," Shaffran says. IUI is a fairly low-tech procedure in which
sperm is injected directly into the uterus to meet - and hopefully fertilize --
a waiting egg.
"We try this for three to six months and if we are unsuccessful, then I may
try an injectable and IUI," she says. Injectable drugs also stimulate
ovulation, but are stronger than Clomid. As such, the use of injectables has an
even greater risk of multiple pregnancies.