Infertility Tests: 1 of 5 things you really need to know about infertility
A Couple’s Guide to Infertility
(Dr Eric Daiter, Board Certified in Reproductive Endocrinology and Infertility)
The goal of this guide is to provide a medical expert’s answers to the common questions:
- Do I have infertility?
- What causes infertility?
- How are specific problems with fertility diagnosed?
- Which treatments for infertility are successful and what are their risks?
- What options exist if all of the infertility testing and treatments do not successfully result in a pregnancy?
How are specific problems with fertility diagnosed?
For couples with difficulty getting pregnant, with no previously identified cause, I start with a thorough medical history, including any history of irregular menstrual cycles or pregnancies. Then I often suggest four basic diagnostic tests that are relatively affordable, low risk, easy to perform, and provide a lot of valuable information.
- The woman’s blood is checked for hormone imbalances (that can lead to problems with the eggs that are released at ovulation) and ovarian reserve (the relative supply of eggs remaining in the ovaries that are able to be fertilized and might result in a successful pregnancy). This blood work is ideally performed on menstrual cycle day 2-4, where cycle day 1 is the first day of heavy flow
- The man’s semen is checked for several variables including sperm concentration, sperm motility and the shape (morphology) of the sperm. A semen analysis is very informative, however, it cannot provide very reliable information about sperm function (the sperm’s ability to fertilize an egg).
- The woman’s cervical mucus is examined several hours after having sex to determine whether the sperm within the mucus is moving normally. For several days prior to ovulation, sperm usually lives comfortably within the cervical mucus for several days after intercourse and travels periodically up to the fallopian tubes to attempt to fertilize an egg. A hostile cervical mucus and sperm relationship can result in few or no sperm being able to travel to the fallopian tubes to fertilize the egg.
- A hysterosalpingogram (HSG) is performed between cycle days 6-13. This HSG test uses x-rays to provide information about the uterine cavity (including the presence of scar tissue, endometrial polyps or fibroids within the cavity) and the fallopian tubes (including any blockages, dilatation, abnormal spillage). I offer to perform the HSG test myself for any of my ongoing patients since they rarely have discomfort when I perform the test, I can make adjustments during the test to obtain the most amount of information, I get immediate results that I can review with my patients, and the test often costs less.
Any abnormalities that are revealed by these diagnostic tests are discussed along with their appropriate treatment options. If the results from these initial basic tests are all normal, or the treatments for test abnormalities do not result in restored fertility, then further diagnostic testing is indicated.
Many pelvic abnormalities, including endometriosis and pelvic adhesions, may be suspected by a woman’s symptoms or medical history, but can only be diagnosed by direct visualization. A pelvic evaluation with laparoscopy and hysteroscopy is minimally invasive day stay surgery (an overnight stay in the hospital is not necessary) and can identify and treat most pelvic pathology that causes reduced fertility. The success of this surgery at restoring reproductive potential largely depends on the skill of the surgeon, so tremendous care should be exercised when choosing your doctor to perform this procedure. I believe finding a board certified Reproductive Endocrinology and Infertility specialist is a good start, when available, and finding one that specializes in pelvic repair rather than focusing their clinical practice primarily on IVF can also be very helpful.
If the pelvic evaluation is normal, or an experienced and skilled reproductive surgeon repairs the pelvis without restoration of fertility, then treatments for “unexplained infertility” are usually appropriate. These treatments can include the use of ovulation enhancing medications during controlled ovarian hyperstimulation (attempting to produce several mature eggs per ovulation cycle) coupled with either intrauterine insemination (IUI) or in vitro fertilization (IVF).
The final section of this Guide, “What options exist if all of the infertility testing and treatments do not successfully result in a pregnancy?,” is only available on the complete downloaded copy. If you like what you have been reading then download your entire free copy of “A Couple’s Guide to Infertility,” written entirely by Dr. Daiter
A video testimonial that expert treatment of infertility can truly accomplish remarkable results!
These brave “real life” stories present examples of the kind of care that Dr. Daiter provides for his patients.