Doctors arbitrarily diagnose infertility when a couple hasn't conceived a child after 12 months of unprotected and regular sex. Impaired fertility may be a better description, though. Many women who keep trying will get pregnant in the second year or later.
Artificial insemination is a technique that can help treat certain kinds of infertility in both men and women. In this procedure, sperm are inserted directly into a woman's cervix, fallopian tubes, or uterus. This makes the trip shorter for the sperm and bypasses any possible obstructions. Ideally, it makes pregnancy possible where it wasn't before. Intrauterine insemination (IUI), in which the sperm is placed in the uterus, is the most common form of artificial insemination.
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Experts recommend visiting a doctor for an infertility evaluation after six to 12 months of unprotected and regular sex without pregnancy. Infertility testing is best done by an infertility specialist.
The first step is a detailed interview. A thorough infertility interview should involve both partners, and ask about:
Your medical histories, including any chronic illnesses or surgeries
Your use of prescription medication
Your use of caffeine, alcohol, cigarettes, and drugs
Your exposure to chemicals, toxins, or radiation in the home or at work
Whether either of you has had sex outside the relationship
Infertility is due to problems related to the woman about two-thirds of the time. A doctor will likely ask a woman questions about her gynecologic history:
Have you been pregnant before and what was the outcome of those pregnancies?
How often have you had periods over the last year?
Have you had irregular and missed periods or had spotting between periods?
Have you had any changes in blood flow or the appearance of large blood clots?
What methods of birth control have you used?
Have you seen a doctor before for fertility problems and undergone treatment for them?
Infertility Tests for Women
There is no single best test or ideal workup for infertility. In practice, doctors perform multiple tests and exams to identify any problems that might be contributing to a woman's infertility.
Most women are familiar with this basic gynecologic test. The Pap smear and pelvic exam are best at detecting cervical cancer, other problems with the cervix, or active sexually transmitted diseases. Any of these can interfere with fertility in women.
In order to get pregnant, a woman has to release an egg each month (ovulation). Women who have inconsistent periods may need testing to confirm they're ovulating. Tests related to ovulation include:
A urine test at home can detect luteinizing hormone (LH), which appears in high levels in the urine just before ovulation.
The doctor may check levels of the hormone progesterone in a woman's blood. Increases in progesterone indicate ovulation.
A woman can check her body temperature each morning. Basal body temperature rises a bit just after ovulation. By checking her body temperature each morning, a woman can detect this rise, showing her ovulation pattern over months.
The doctor may also run tests on a woman's thyroid, or check for other hormonal problems, to rule out underlying causes of missed or irregular ovulation.
Tests of Reproductive Organs
The uterus, fallopian tubes, and ovaries must all be working well in order to get pregnant. Different procedures can check the health of these organs:
Hysterosalpinogram. Also called an HSG or "tubogram," a series of X-rays is taken of the woman's fallopian tubes and uterus after a liquid dye has been injected through the vagina. Another method involves using saline and air instead of dye and an ultrasound. The HSG can help diagnose fallopian tube blockages and defects of the uterus. If one of the tubes is blocked, the obstruction should be seen on an X-ray. An HSG is usually done just after a menstrual period.
Transvaginal ultrasound. An ultrasound wand is introduced into the vagina to bring it close to the pelvic organs. Using sound waves, a doctor can see images of the ovaries and uterus. Often the doctor can determine whether there are follicles in the ovaries.
Hysteroscopy. A thin, flexible tube with a camera on its lighted end is threaded through the cervix into the uterus. The doctor can see problems with the uterus, and take tissue samples if needed.
Laparoscopy. Small cuts are made in the abdomen and tools including a camera inserted into the belly. This surgery can evaluate the entire pelvis and potentially correct problems, such as endometriosis. However, laparoscopy is invasive and involves small risks.