Infertility is a serious worry for many couples because it's a diagnosis that has the potential to dramatically alter the life that you always imagined for yourself.
But infertility is not as bleak as you might imagine. Although a person may be considered infertile after one full year of trying to conceive, 12 months may not mean that much. One recent study conducted by the National Institute of Environmental Health Sciences found that the majority of women up to age 39 who didn't become pregnant in their first year did become pregnant in their second year -- without any medical assistance. For women between ages 27 and 34, only 6% were unable to conceive in their second year. And for 35- to 39-year-old women, only 9% were unable to conceive in their second year -- provided their partner was under 40.
Going to the Infertility Doctors
If you're concerned about infertility, the best thing to do is to make an appointment with a doctor, preferably an infertility specialist. They will start by talking with you and your partner about your medical health and habits. Although you may find some of the questions awkward or embarrassing, it's the best way to evaluate what might be causing your trouble. In many cases, infertility is the result of a combination of problems, sometimes in each partner, which makes a thorough examination important.
Before you see a specialist, make sure that you understand the costs of infertility tests, and whether your insurance will cover them.
Your doctor will probably ask you both 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.
- Your sexual habits, including how often you have sex, any history of sexual problems or sexually transmitted diseases, and whether either of you have had sex outstide the relationship.
- Your choice of underwear -- if you're a man, that is -- since tight fitting briefs can keep the scrotum temperature too warm for normal sperm production.
Your doctor will also want to ask about a woman's gynecologic history and ask you:
- Whether you've been pregnant before and the outcome of those pregnancies
- About the frequency of your periods over the last year
- Whether you've been irregular and missed periods or had spotting between periods
- About any changes in blood flow or the appearance of large blood clots
- About what methods of birth control you've used
- Whether you've seen a doctor before for fertility problems and undergone treatment for them
If you have seen a doctor about fertility problems before, make sure to bring all fertility-related medical records and X-rays or sonograms with you, or at least have them sent ahead.
Blood Tests and Semen Analysis
Once the interview is out of the way, your infertility workup will likely begin with a physical exam and blood tests to check levels of female hormones, thyroid hormones, prolactin, and male hormones, as well as for HIV and hepatitis.
The physical exam may include a pelvic examination to look for chlyamydia, gonorrhea, or other genital infections that may contribute to the fertility problem.
The male partner may also need to be evaluated for genital infections. Your doctor will suggest a complete semen analysis for the male partner to check the number, shape, and motility of the sperm.
Your doctor may schedule other blood tests around the woman's menstrual cycle. For example, tests for follicle stimulating hormone (FSH) and luteinizing hormone (LH) must be done on day two or three of your cycle. Luteinizing hormone surges in the middle of your menstrual cycle -- in the mid-luteal phase -- so you may need to come in for more tests then, and again about seven days after you begin ovulating. After you're ovulating, your doctor will also test your estradiol and progesterone levels and compare them with the levels taken on day two or three of your cycle.
Other Tests and Procedures
- BBT charting. If you haven't already been doing it, your doctor may recommend that you begin charting your basal body temperature as a way of checking ovulation. However, while BBT charting is a technique that has been used for ages, experts don't believe that it is as accurate as other ovulation tests.
- Postcoital test. This test requires that you have intercourse several hours in advance and then visit your doctor to have a sample of cervical mucus taken for microscopic examination. It's a way of testing both the viability of the sperm and their interaction with the cervical mucus.
- Transvaginal (pelvic) ultrasound exam. Your doctor might recommend an ultrasound to check the condition of the uterus and ovaries. Often the doctor can determine whether the follicles in the ovaries are working normally. Thus, the ultrasound is often performed 15 days before a woman's expected menstrual period.
- Hysterosalpinogram. Your doctor may also suggest a hysterosalpinogram, also known as an HSG or "tubogram." In this procedure, a series of X-rays is taken of your fallopian tubes after a liquid dye has been injected into your uterus through your cervix and vagina. The HSG can help diagnose fallopian tube blockages and defects of the uterus. If one of the tubes is blocked, the obstruction should be apparent on the X-ray since the liquid dye won't get past it. An HSG is usually scheduled between days six and 13 of your cycle.
- Hysteroscopy. If a problem is found in the HSG, your doctor might order a hysteroscopy. In this procedure, a thin teloscope-like instrument is inserted through the cervix into the uterus to allow the doctor to see and photograph the area to look for problems.
- Laparoscopy. After the above tests have been done, your doctor may want to do a laparoscopy. In this, a laparoscope is inserted into the abdomen through a small incision to look for endometriosis, scarring, and other conditions. This procedure is a little more invasive than an HSG and requires that you go under general anesthesia.
- Endometrial biopsy. Your doctor may want to take a biopsy of your uterine lining to see if it's normal, so an embryo could implant in it. During an endometrial biopsy, a doctor removes a sample of tissue from the endometrium with a cathether that is inserted into the uterus through the vagina and cervix. The sample is analyzed in the lab. The procedure is somewhat uncomfortable; therefore, a painkiller is given beforehand.
Not all women undergo all these tests. Your doctor will guide you through those that are most appropriate for your situation. After the testing is done, about 85% of couples will have some idea why they're having trouble getting pregnant.